SURGICAL TOOLS — set of tools, devices, the devices intended for performance of surgery. By means of X. and. the surgeon makes various manipulations connected with division of fabrics, removal of affected areas, creation of convenient access to the operated body, etc. Improvement of operational receptions, implementation of new methods involves creation of new types of X. and., what gives the chance to surgeons to carry out operations, to-rye were considered as impracticable earlier.
History of emergence and improvement of X. and. it is directly connected with history of development of medicine (see). Consider that by means of primitive stone tools in the Neolithic era made a craniotrypesis. Surgical instruments found at excavation in Greece, Italy, Egypt, India. However the ground mass of the tools reminding modern in a form and appointment was created in 16 — 18 centuries.
In Russia X. and. handicraftsmen produced (armorers, founders, smiths, etc.). In 1721 under Peter I's decree in St. Petersburg on the Pharmaceutical island the first workshop on production X was organized. and. «A tool log hut» (nowadays Orders of Lenin and awards of the October revolution Leningrad production association «Krasnogvardeets»). In 1738 the catalog was made, in to-ry all surgical instruments which were issued during this period in Russia entered. The majority of surgical instruments was artly inlaid, trimmed by silver and a bone.
In 1829 I. V. Buyalsky became the managing St. Petersburg tool plant. It collected a collection of samples of tools, on the Crimea the plant produced surgical instruments in bulk. I. V. Buyalsky offered a number of tools of own design: a rake for
a pushing off of interiors, a tourniquet for a stop of bleeding, the device for hemotransfusion of an original design, etc. At it the plant released St. 25 special surgical sets. Since 1841 the director of a technical part of this plant N. I. Pirogov consisted. At that time at the plant new surgical instruments and sets were designed (12 of them the Russian surgeons applied within 50 years). In 1883 the full catalog X was made. and. The St. Petersburg tool plant with the exact description and the indication of cost both tools, and their repair.
With introduction of an asepsis (see) the new period of development of X began. and. Tools of an irregular geometrical shape, with incrustations and jewelry from a bone, nacre, gold were replaced with tools of simpler form and design with a smooth and plain surface. They were produced from the homogeneous material, chemically resistant, maintaining repeated boiling. X. and., meeting these requirements, in Russia it was made by the Moscow enterprise Schwab. Descriptions and images of 3174 various surgical instruments are presented in the catalog of the enterprise published in 1877.
Big contribution to creation of X. and. the Russian surgeons S. I. Spasokukotsky brought, to-ry designed special set for went. - kish. surgeries, Yu. K. Szymanowski, to-ry invented St. 20 tools (among them there is a resection saw, a needle for seams, knives of various form, etc.), S. P. Fedorov who designed the tools used at kidney operations, L. G. Bel-lyarminov who designed eye tools, D. O. Ott — gynecologic tools, etc. Many eurysynusic surgical instruments were offered by foreign surgeons: various krovoostanavl
the howling clips — T. Biljrot, T. Kokher, Zh. Pean, a press intestinal and a dilator costal — I. Mikulich, etc.
For years of the Soviet power the small semi-handicraft enterprises for production X. and. turned into large enterprises of the medical industry, to-rye release all necessary for equipment to lay down. - the prof. of institutions X. and. (see Health care, the Medical industry). The in-t of medical equipment in Moscow both All-Union research and design in Kazan, and also design offices is engaged in in-t of medical tools in development of new surgical instruments and improvement of technology of their production All-Union research and test at a number of the plants. Again developed surgical instruments pass several types of tests: technical, experimental (on animals) and the clinical countries in the lead medical agencies (see Standardization). Positive takes of tests are the basis for their recommendation in a wedge, practice and industrial production.
X. and. is issued only according to the technical specifications approved by M3 of the USSR and Min-vom of the medical industry of the USSR, to-rye are the main document defining quality of a product and compliance to its functional purpose. Lists and characteristics of X. and., released in the USSR, contain in the catalogs published by M3 of the USSR and Min - vy the medical industry of the USSR, and released abroad — in catalogs of the releasing and trading firms. Supply of X. and. healthcare institutions carries out
Soyuzmed-tekhnika all-union association at M3 of the USSR, the association «Medical equipment» (republican, regional, regional) through drugstores and shops (see Soyuzmedtekhni), export abroad — Medeksport All-union association.
Development of X. and. it is carried out in various ways. 1. The invention of the original tools based on the new principle. E.g., a needleless injektor (see Injek-tor needleless); staplers (see) forced out a gastrorrhaphiotom, the Crimea used for compression of walls of a stomach, underrunning their needle and cutting off of the deleted part at a gastroenterostomy across Telkov earlier; a new technique and new lithomyls (see. Urological tools) — the knives-litotomy before applied to a perineal kakhmnesecheniye and extraction of stones from a bladder, etc. 2. Improvement of already known designs, napr, forms and the sizes of styptic clips and tweezers, transition to the box-shaped lock, use for production of tools of polymeric materials, napr, for buzhy (see), titanium alloys and other materials. 3. Resuming of old designs on a new basis. E.g., Egorov's nippers — Freydlina for a vykusyvaniye of sites of a bone at neurosurgical and all-surgeries are modification of nippers of Egorov for backbone operations, stupid ligature needles (left and right) for leading of a ligature under sosud& in children's surgery — modification of needles of Deshan (see Eagles medical), styptic clips — modification of an angiotribe! The dean (see Angiotripsy), etc.
New types of needle holders excluded use of needle holders of Hagedorn, etc.
Originally surgical instruments produced from iron, then from carbon steel, copper, brass, silver and other material. In a crust, time for production X. and. pure metals do not apply, and use alloys. The vast majority of surgical instruments make of chromic stainless steels of brands 20X13, 30X13, 40X13
(the first figure of a steel grade — the average content of carbon in the 100-th shares of percent, letters — chrome, figure 13 — its average content as a percentage). For increase in corrosion firmness of a product from these steel grades shall be tempered and have faultlessly smooth surface (e.g., polished). Tool steel of the U7A brands — U12A (a letter U — carbon, figure — its content from 0,7 to 1,2%, a letter A indicates high quality of steel) is applied to production of hl. obr. cutting instruments. Products from these staly after tempering get the high hardness and the good cutting properties, however they are subject to strong corrosion. For corrosion protection tools from this steel cover in the galvanic way with a layer of nickel or chrome. The high-alloy steels which are not demanding for obtaining the necessary firmness of high-temperature tempering are used for production of tools with tiny working parts (eye tools, tools for microsurgery). Copper alloy with zinc — brass of the JI62 brand, containing apprx. 62% of copper, is applied to production of catheters, probes, disinfection boilers, and the alloy of the JIC 59-1 brand on average containing 59% of copper, 1% of lead and 40% of zinc — to production of fittings for syringes, cannulas of needles and troakar. Copper alloy with nickel and zinc — a German silver has high corrosion resistance. Make tracheotomic tubes, cannulas of it, etc.
Surgical instruments have generally brilliant, polished surface improving their anticorrosive properties and giving them a beautiful look. However the brilliant surface of tools promotes creation of patches of light in a surgery field, to-rye, reflecting light of lamps, prevent to work to the surgeon. Therefore recently began to release tools with a mat surface.
Began to apply alloys of titanium to production of surgical instruments. The tools manufactured of this material differ in the small weight (weight), high corrosion resistance. They are more long-lasting than the tools manufactured of chrome stainless steel, approximately by 5 times. The surface of tools from titanium does not need corrosion protection; it is often given various color (golden, blue, blue, green, crimson) that allows to make color marking of groups of tools and facilitates use of them. It is especially important for microsurgical instruments with tiny working parts (see Microsurgery). Handles of tiny hooks, e.g., Ikhmeyut blue color, raspatories — green, knives — golden. For production of surgical instruments use also noble metals — silver, platinum, and as a suture material — tantalum or alloy of cobalt, chrome, nickel, molybdenum with addition of other elements.
Non-metallic materials (plastic, rubber) apply to production of catheters, buzhy, tracheotomic tubes, syringes. Production of surgical instruments from plastic for the one-time use gains distribution (tweezers, syringes, pallets, scalpels with steel edges, syringe needles), to-rye are issued in sterile packaging.
X. and. includes products, various on a design, beginning from the tools consisting of one detail (a scalpel, the pallet), and finishing the mechanized tools with a hand, electro-and pneumatic actuator. Total quantity of types of surgical instruments reaches several thousand names. It is traditional X. and. it is classified by the principle of use and is divided into tools for anatomic researches — napr, the hammer anatomic with a hook, a knife brain (see. Anatomic tools, Section tools); tools for diagnosis — napr, the hammer neurologic, tool kit for a research of tendon jerks; the tools for operative measures intended for all-surgical (so-called all-surgical instruments), neurosurgical, ophthalmologic, otorhinolaryngological and other operations; accessory instruments, accessories and devices — screw-drivers, keys, handles, measuring tools etc.
There is a classification of X. and. on the basic functional purpose. On this classification it is divided into a number of groups. 1. The tools pricking for punctures, the yin
of ektion sewings together of fabrics etc., needles — injection, for capture and hemotransfusion, for suction of plasma, surgical (see Eagles medical), needles cannulas (the tab., fig. 1), troakara for a puncture of cavities, in particular at newborns, troakary-catheters (the tab., fig. 2) etc., syringes for injections, injections, washings of cavities (see Syringes). 2. The tools cutting for a section of fabrics: knives, lancets, various scalpels (the tab., fig. 3, 4, 5), including scalpels with the limiter (see Knives surgical), chisels for a section of a bone, removal of new growths on bones, openings of cavities in tubular bones and chisels for crushing of bone tissues at ear operations (see. Otorhinolaryngological tools), valvulotomes for a section of shutters of valves of heart and the main vessels (the tab., fig. 6), vyku-syvatel for a vykusyvaniye, removals of sites of a soft and bone tissue (e.g., a vykusyvatel of shutters of valves of heart; the tab., fig. 7), nippers — for a perekusyvaniye, a sku-syvaniye (e.g., nippers for the I edge; the tab., fig. 8), scissors for a section of soft, bone tissues — rasslaivayushche-cutting, on the end of one edge to-rykh is available the wedge-shaped platform allowing to divide previously fabrics and to exclude their excessive traumatization (the tab., fig. 9), and for auxiliary manipulations (see Scissors surgical); saws for sawing of bones at resections, amputations and other operations, for cutting of plaster bandages (the tab., fig. 10) — knife (the tab., fig. 11), frame (the tab., fig. 12), sheet, wire (see. Neurosurgical tools., Orthopedic tools); drills and mills — tools for channeling, drilling of openings in bones, and also dental borers (see. Dental tools); the tools scraping — spoons for a scraping of fistulas, captures of a biopsy (the tab., fig. 13, 14, 15), removals of the softened bone tissue, raspatories for department of a periosteum, a pleura, skin (the tab., fig. 16, 17, 18), gums. 3. The tools which are pushing aside: dilators for creation of convenient access to the operated site — ranorasshiritel (the tab., fig. 24), mirrors, shovels, pallets, hooks, elevators (see Dilators), dissectors — for division of fabrics, allocation of tubular bodies, temporary crossclamping of blood vessels, channels, capture of a ligature (the tab., fig. 19, 20, 21, 22,23). 4. Tools tightening: for crossclamping of bodies, fabrics, channels, vessels (the tab., fig. 25, 26), for an attachment of operational linen, etc. (see Clips surgical). Also the packers intended for introduction of tampons and drainages to depth of a wound, removal of foreign bodys, giving of sterile tools and dressing materials, and also tweezers surgical, anatomic and special concern to this group of tools (see Tweezers); the nippers intended for capture, keeping of various fabrics, removal of foreign bodys and other purposes (see Nippers medical) i; needle holders (the tab., fig. 27, 28) for keeping of surgical needles at suture; clip-on earrings (tab., fig. 29); the tools crushing, causing destruction of fabrics — presses gastric, intestinal, intended for strong keeping of body, impose them on the deleted part of body. 5. The tools probing and buzhiruyushchy for introduction with the diagnostic and medical purposes in natural or patol. channels and cavities (see Bougie, Probes). Catheters (see), cannulas (see) are intended for removal of liquids, slime, washing of cavities, inhalation of oxygen and other purposes (see the Intubation). 6. The tools mechanized: for connection (sewing together) of bodies and fabrics metal brackets (see Staplers); tools with a spring, electro-and pneumatic actuator, napr, injektor needleless (see) for carrying out mass inoculations, a dermatoma (see) for cutting of skin transplants at skin transplantation, etc. 7. Accessory instruments: the accessories
and devices which are not adjoining directly to body tissues, but necessary at operations (hammers, screw-drivers, rotations etc.).
The medical sets containing different types of tools are intended for performance of certain operative measures (for pulmonary surgery, for operations on bilious channels, on a gullet etc.) or for rendering a certain objekhm of medical aid (big operational set, small operational set, etc.). They are especially convenient for a field and urgent surgery.
Sterilization of surgical instruments is carried out thermal, chemical and radiation in the ways (see Sterilization). In to lay down. institutions apply generally thermal methods of sterilization by means of steam or air sterilizers (see Sterilizers). Steam sterilization is made at t ° 120 — 132 ° and
pressure of 1,1 — 2 kgfs/cm2, a hot air at a temperature apprx. 200e. The surgical instruments having a trimming blade or made of thermolabile materials, changing the properties after high-temperature processing, will sterilize in the chemical way, maintaining certain time in a liquid antiseptic agent (naira., 6% solution of hydrogen peroxide) or gaseous chemical substances. Disinfection of surgical instruments is made by boiling in water in disinfection boilers or keepings in 3% solution of hydrogen peroxide, 5% solution of phenol, etc. Ways of sterilization and disinfection of a specific surgical instrument are specified in the passport or on packaging of the tool. After operation X. and. disinfect immersion in solution of phenol, hydrogen peroxide or other chemical substance, wash with a stream of warm water, will sterilize one of the listed ways and place for storage in a medical case (see Disinfection). The ends pricking and edges of cutting instruments need to be protected from damage therefore such tools stack on supports or put on the working ends, especially microtools, pieces of polyethylene or rubber tubes. The tools having to a kremalyer shall be locked only on the first tooth kremalyer that she was relaxed. In need of long-term storage of X. and. shall be in packaging of manufacturer; lubricant through a certain period should be replaced. Repair of X. and. during a warranty period carries out manufacturer.
T and persons
SOME TYPES of ALL-SURGICAL INSTRUMENTS AND THEIR BASIC PURPOSE
the Name of tools (in brackets number of the drawing is specified)
the Total length (L), the size of a working part: length (Oh, width (£), diameter (d); radius of a bend (R)
&of the nbsp tool;
Note. The table included the tools which are not given in other articles BME. See &takzhenbsp; Clips are surgical, Neurosurgical tools, Knives surgical, Tweezers, Dilators, Nippers &meditsinskiyenbsp; etc.
Bibliography: Borodulin F. R. History of medicine, Chosen lectures, M., 1961; To and and t about in Yu. F. Medical tools, equipment and equipment, M., 1977; T and m and to about in In * D. Chelovek, medicine and scientific and technical progress, M., 1971; Thompson of Page J. S. Evolution and development of surgical instruments, Brit. J. Surg., v. 25, p. 1, 1937.
M of H. Vyrzhikovskaya.