Surgery instruments like a safety scalpel must be kept in proper shape as they are vital towards carrying out an operation properly in USA. Surgical instruments are designed to ensure that the surgeons can complete surgeries in an effective and safe manner using safety scalpels and other tools. Surgeries are mainly held to modify or remove any kind of body tissues. Surgical instruments also come in a variety of types designed to do separate things. They are categorized based on their usage. Also they are sometimes categorized according to the materials they are made of.
Disposable and non disposable surgical scalpels:
The scalpel is one of the most common surgical instruments, and recently safety scalpels in USA are the most used of them. These are used for incisions or thin cuts on the flesh to reach the inner organs. The retractors are used used to keep the cuts open so that the surgeons can reach in and go through with the operation. Forceps are another popular surgical instrument which is used for picking and holding tissues. When it comes to cutting tissues scissors are also used but these scissors are not the same as the household ones. These are much more precise and effective. All these instruments are made from hardened and tampered steel. After considering their composition they are labelled as reusable or not. There are also other surgical instruments which are made for just one time usage. These are destroyed after usage like the disposable surgical needles. Disposable surgical scalpels are always sterilized the moment they are purchased in home and hospital departmental stores in USA. These disposable tools are generally made from runner or plastic materials. Protective surgical gloves, twin bone nasal catheter, nasal oxygen catheter, oxygen mask, suction catheter, and trachea’s tony tubes are few examples of these types of instruments.
Electrosurgery instead of a Scalpel Cut
Hospitals can be scary sometimes but we can’t deny the fact that millions of lives are saved in these institutions every day. Being a doctor is definitely not an easy affair. Not only do these professionals have to become masters in understanding human biology but they also have to perfect their skills and capabilities of using various medical instruments. Can you think of a painter without the required paint brushes? Or a carpenter without his tools? Similarly, a doctor without his medical devices would be just like an audience on a show where, ideally, he should be performing on stage. No operation or diagnosis or procedure or even test can be carried out without necessary tools and equipment. It is important to know what these tools are and what their utilities are.
So if you are interested in medical tools and procedures and would like to understand how these are carried out, here is a list of the most basic medical instruments that you can find on an operating room. Hope this article helps you in your search for information.
The use of scissors as operating room instruments need not be highlighted or stated. No operation can be done without scissors. Scissors used in surgery come in two main types: Metzenbaum and Mayo scissors. Metzenbaum scissors are used in case of cutting or dissecting soft delicate tissues. Mayo scissors are preferred for cutting hard tissues such as joints. These scissors are used to cut thick tissues located in the breast and the muscles. Made up of stainless steel, these scissors are usually manufactured in variable lengths.
Whether it is a major or a minor operation, a scalpel plays a very vital role in all of them. It is a knife that comes with stainless steel blades. Each and every surgery has its different needs but during every surgery, a correct incision is a must which cannot be carried out without a scalpel.
Forceps look like kitchen tongs. It allows the surgeon to hold and grasp the skin tissues firmly. Whether it is clamping the arteries or holding a part of intestine while operating, forceps can be relied upon. Also, this surgical instrument comes in a range of sizes so that the surgeon can choose one depending upon the need of the situation. The large ones are designed to hold a baby’s head and their main purpose is to safely get the baby out from the birth canal during a cesarean.
Of course there are other tools as well which will vary from surgery to surgery. They are manufactured with a wide variety of materials like platinum, stainless steel, tungsten carbide, chromium and other non-reactive and high strength metals. Designs and applications of medical devices have also evolved much over time. The more we advance into health care and medical science, the more new tools and equipment we will create for aiding surgeons in performing life saving procedures.
Surgical Staple after an Operation
Electrosurgery is the application of a high-frequency (radio frequency) alternating polarity, electrical current to biological tissue as a means to cut, coagulate, desiccate, or fulgurate tissue. Its benefits include the ability to make precise cuts with limited blood loss. Electrosurgical devices are frequently used during surgical operations helping to prevent blood loss in hospital operating rooms or in outpatient procedures.
In electrosurgical procedures, the tissue is heated by an electric current. Although electrical devices that create a heated probe may be used for the cauterization of tissue in some applications, electrosurgery is usually used to refer to a quite different method than electrocautery. Electrocautery uses heat conduction from a probe heated to a glowing temperature by a direct current (much in the manner of a soldering iron). This may be accomplished by direct current from dry-cells in a penlight-type device.
Electrosurgery, by contrast, uses radio frequency (RF) alternating current to heat the tissue by RF induced intracellular oscillation of ionized molecules that result in an elevation of intracellular temperature. When the intracellular temperature reaches 60 degrees C, instantaneous cell death occurs. If tissue is heated to 60-99 degrees C, the simultaneous processes of tissue desiccation (dehydration) and protein coagulation occur. If the intracellular temperature rapidly reaches 100 degrees C, the intracellular contents undergo a liquid to gas conversion, massive volumetric expansion, and resulting explosive vaporization.
Appropriately applied with electro surgical forceps, desiccation and coagulation result in the occlusion of blood vessels and halting of bleeding. While the process is technically a process of electrocoagulation, the term "electrocautery" is sometimes loosely, nontechnically and incorrectly used to describe it. The process of vaporization can be used to ablate tissue targets, or, by linear extension, used to transect or cut tissue. While the processes of vaporization/ cutting and desiccation/coagulation are best accomplished with relatively low voltage, continuous or near continuous waveforms, the process of fulguration is performed with relatively high voltage modulated waveforms. Fulguration is a superficial type of coagulation, typically created by arcing modulated high voltage current to tissue that is rapidly desiccated and coagulated. The continued application of current to this highly impedant tissue results in resistive heating and the achievement of very high temperatures - enough to cause breakdown of the organic molecules to sugars and even carbon, thus the dark textures from carbonization of tissue.
Diathermy is used by some as a synonym for electrosurgery but in other contexts diathermy means dielectric heating, produced by rotation of molecular dipoles in a high frequency electromagnetic field. This effect is most widely used in microwave ovens or some tissue ablative devices which operate at gigahertz frequencies. Lower frequencies, allowing for deeper penetration, are used in industrial processes.
RF Electrosurgery is commonly used in virtually all surgical disciplines including dermatological, gynecological, cardiac, plastic, ocular, spine, ENT, maxillofacial, orthopedic, urological, neuro- and general surgical procedures as well as certain dental procedures.
RF Electrosurgery is performed using a RF electrosurgical generator (also referred to as an electrosurgical unit or ESU) and a handpiece including one or two electrodes - a monopolar or bipolar instrument. All RF electrosurgery is bipolar so the difference between monopolar and bipolar instruments is that monopolar instruments comprise only one electrode while bipolar instruments include both electrodes in their design.
The monopolar instrument called an "active electrode" when energized, requires the application of another monopolar instrument called a "dispersive electrode" elsewhere on the patient's body that functions to 'defocus' or disperse the RF current thereby preventing thermal injury to the underlying tissue. This dispersive electrode is frequently and mistakenly called a "ground pad" or "neutral electrode". However virtually all currently available RF electrosurgical systems are designed to function with isolated circuits - the dispersive electrode is directly attached to the ESU, not to "ground". The same electrical current is transmitted across both the dispersive electrode and the active electrode, so it is not "neutral". The term "return electrode" is also technically incorrect since alternating electrical currents refer to alternating polarity, a circumstance that results in bidirectional flow across both electrodes in the circuit.
Bipolar instruments generally are designed with two "active" electrodes, such as a forceps for sealing blood vessels. However, the bipolar instrument can be designed such that one electrode is dispersive. The main advantage of bipolar instruments is that the only part of the patient included in the circuit is that which is between the two electrodes, a circumstance that eliminates the risk of current diversion and related adverse events. However, except for those devices designed to function in fluid, it is difficult to vaporize or cut tissue with bipolar instruments.
Neural and muscle cells are electrically-excitable, i.e. they can be stimulated by electric current. In human patients such stimulation may cause acute pain, muscle spasms, and even cardiac arrest. Sensitivity of the nerve and muscle cells to electric field is due to the voltage-gated ion channels present in their cell membranes. Stimulation threshold does not vary much at low frequencies (so called rheobase-constant level). However, the threshold starts increasing with decreasing duration of a pulse (or a cycle) when it drops below a characteristic minimum (so called chronaxie). Typically, chronaxie of neural cells is in the range of 0.1–10 ms, so the sensitivity to electrical stimulation (inverse of the stimulation threshold) decreases with increasing frequency in the kHz range and above. (Note that frequency of the alternating electric current is an inverse of the duration of a single cycle). To minimize the effects of muscle and neural stimulation, electrosurgical equipment typically operates in the radio frequency (RF) range of 100 kHz to 5 MHz.
Operation at higher frequencies also helps minimizing the amount of hydrogen and oxygen generated by electrolysis of water. This is especially important consideration for applications in liquid medium in closed compartments, where generation of gas bubbles may interfere with the procedure. For example, bubbles produced during an operation inside an eye may obscure a field of view.
There are several commonly used electrode configurations or circuit topologies:
With "bipolar" instruments the current is applied to the patient using a pair of similarly-sized electrodes. For example, special forceps, with one tine connected to one pole of the RF generator and the other tine connected to the other pole of the generator. When a piece of tissue is held by the forceps, the RF alternating polarity electrical current oscillates between the two forceps tines, heating the intervening tissue by the previously described synchronous oscillation of intracellular ions.
In monopolar configuration the patient is attached to the dispersive electrode, a relatively large metal plate or a flexible metalized plastic pad which is connected to the RF generator or electrosurgical unit (ESU). The surgeon uses a pointed or blade shaped electrode called the "active electrode" to make contact with the tissue and exert a tissue effect...vaporization, and it's linear propagation called electrosurgical cutting, or the combination of desiccation and protein coagulation used to seal blood vessels for the purpose of Hemostasis. The electric current oscillates between the active electrode and the dispersive electrode with the entire patient interposed between the two. Since the concentration of the RF current reduces with distance from the active electrode the current density rapidly (quadratically) decreases. Since the rate of tissue heating is proportional to the square of current density, the heating occurs in a very localized region, only near the portion of the electrode, usually the tip, near to or in contact with the target tissue.
On an extremity such as a finger, there is limited cross-sectional area to disperse the current, a circumstance which might result in higher current density and some heating throughout the volume of the extremity.
Another bipolar instrument is characterized with both electrodes on the same design, but the dispersive electrode is much larger than the active one. Since current density is higher in front of the smaller electrode, the heating and associated tissue effects take place only (or primarily) in front of the active electrode, and exact position of the dispersive electrode on tissue is not critical.
- USA stainless steel blade
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- Philadelphia ultrasonic scalpel
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- Atlanta dissecting scissors
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- Memphis microtome blades
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- Louisville dissecting scissors
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