Instrumentation for the operating room 2016

   3-8 Left to right: Deaver retractors,
small, medium, and large; Ochsner
malleable retractors, narrow, medium,
and wide.

AB CD

AB CD

3-9 Left to right: A, Adson tissue forceps and tip; B, Ferris Smith tissue forceps and tip; C, Russian tissue
forceps and tip; D, DeBakey vascular atraugrip tissue forceps and tip.

CHAPTER 3  Operating Room Suite/Basic Laparotomy 35

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3-10 Left to right: A, Paper drape clip   A BC
and tip; B, Halsted mosquito hemostat-
ic forceps, straight, and tip; C, Halsted
hemostatic forceps and tip.

AB C

3-11 Left to right: A, Crile hemostatic A BC
forceps and tip; B, Allis tissue forceps
and tip; C, Babcock clamp tissue
forceps and tip.

AB C

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  A BC

AB CD
3-12 Left to right: A, Tonsil hemostatic forceps and tip; B, Westphal hemostatic forceps and tip;
C, Mayo-Péan hemostatic forceps, curved, and tip; D, Mixter hemostatic forceps, fine-point tip.

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  3-13 Left to right: A, Ochsner A B C
hemostatic forceps and tip;
B, Foerster sponge forceps and tip;
C, Mayo-Hegar needle holder and tip.

A BC
3-14 Basic Mayo stand setup for
closing the skin. After the sponge
count is completed and correct, have
a few instruments, sponges, suture
and needles, or skin stapler available
to complete the skin closure.

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CHAPTER 4

Abdominal Self-Retaining Retractors

Abdominal self-retaining retractors are retractors that do not require a person to hold Additional images are available at:
them in the proper position. Once the surgeon places the retractor and sets the racket, evolve.elsevier.com/Tighe/instrumentation
nut, or universal joint, the retractor stays open until released.

  4-1 Top to bottom: Bookwalter retrac-
tor table post; Bookwalter retractor
horizontal bar; Bookwalter retractor
horizontal flex bar.

4-2 Top to bottom: Bookwalter retrac-
tor oval ring, medium; Bookwalter
retractor: Balfour blades, second
blade, side view.

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4-3 Top to bottom: Bookwalter retrac-    ­
tor: segmented parts (2 segmented
half-circles, medium; 2 segmented
straight extensions) placed together
with 4 locking screws; 1 vertical exten-
sion bar; 1 Kelly retractor blade with
ratchet mechanism attached; 2 post
couplings.
4-4 Left to right: 1 Harrington retrac-
tor blade; 1 Kelly retractor blade
(2 × 6 inch); 1 Kelly retractor blade
(2 × 4 inch); 1 Kelly retractor blade
(2 × 3 inch); 2 Kelly retractor blades
(2 × 2½ inch); 6 ratchet mechanisms; 2
malleable retractor blades (2 × 6 inch);
2 malleable retractor blades
(3 × 6 inch).

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4-5 O’Sullivan-O’Connor retractor   
with 3 blades.
4-6 Top to bottom, left to right:
Balfour abdominal retractor: retractor
frame with 2 detachable shallow
fenestrated blades; 1 shallow center
blade; 2 deep fenestrated blades;
1 deep center blade.

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4-7 Top to bottom, left to right: Upper  
hand retractor: 2 Balfour abdominal
blades, deep and shallow; 1 Deaver
blade, side view; 1 Weinberg blade
(modified Joe’s Hoe); 1 malleable
blade.
4-8 Thompson bariatric posts
and bars.

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    4-9 Thompson bariatric retractor
blades and clamps.

4-10 Left to right: Thompson retractor
rotatable blades: 1 Deaver, medium,
side view; 1 Harrington, side view; 1
Deaver, medium (2½ × 5 inch), side
view; 1 Deaver, large, front view.

4-11 Left to right: Thompson retrac-
tor rotatable blades: 1 finger mal-
leable; 2 Balfour, side view and back
view; 1 rake Murphy, sharp, 3 prong;
1 Balfour-Mayo center (2¾ × 5 inch),
side view.

CHAPTER 4  Abdominal Self-Retaining Retractors 43

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4-12 Left to right: Thompson retrac-   
tor rotatable blades: 1 Weinberg (3¼ ×
5¼ inch), side view; 1 Richardson (2 ×
5 inch), side view; 1 Kelly (2½ × 3 inch),
side view; 1 Kelly (2 × 2½ inch), front
view; 2 Richardson carotid (1 × ¼ inch
and ¾ × 1 inch), side view.
4-13 Top to bottom, left to right:
Thompson retractor joints: 1 exten-
sion arm, angular, 12 inch; 1 wrench,
universal; 1 adapter blade, universal; 2
universal (½ × ¼ inch); 2 universal split
(½ × ¼ inch); 2 universal (½ × ½ inch); 2
universal (½ × ½ inch), large.

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CHAPTER 5

Small Laparotomy Set

A smaller number of instruments may be used for less involved procedures, such as an Additional images are available at:
appendectomy or an inguinal herniorrhaphy. An appendectomy is the removal of the ver- evolve.elsevier.com/Tighe/instrumentation
miform appendix of the bowel. An inguinal herniorrhaphy is the repair of an outpouching
through an abnormal opening in the abdominal muscle wall in the lower right or left quad-
rant of the abdomen. These procedures may also be done through a laparoscope.

A brief description of the instruments follows:
1. Adson tissue forceps without teeth, used for the handling of delicate tissue.
2. Adson tissue forceps with teeth, used for grasping the skin edges.
3. Halsted mosquito hemostatic forceps, used for clamping the bleeders.
4. Babcock clamp tissue forceps, used for handling the appendix or hernia sac.
5. Short Allis forceps, used for grasping the tissue when closing the incision.
6. Weitlaner self-retaining retractor, used for the retraction of the abdominal layers.
7. Farr spring retractors, used for retracting the skin edges.
 
5-1 Top, left to right: 1 Brown-Adson
tissue forceps (9 × 9 teeth); 2 Adson
tissue forceps with teeth (1 × 2).
Bottom, left to right: 2 Bard-Parker
knife handles #3; 1 Cushing forceps
with teeth (1 × 2); 1 Ferris Smith tissue
forceps (1 × 2); 2 DeBakey vascular
atraugrip tissue forceps, medium;
4 paper drape clips; 6 Halsted mosquito
hemostatic forceps, curved; 1 Halsted
mosquito hemostatic forceps, straight;
8 Crile hemostatic forceps, curved,
5½ inch; 1 Halsted hemostatic forceps,
straight; 6 Crile hemostatic forceps,
curved,6½ inch; 4 Allis tissue forceps,
short; 4 Babcock clamp tissue forceps,
short; 4 Ochsner hemostatic forceps,
short; 1 Westphal hemostatic forceps;
2 tonsil hemostatic forceps; 1 Foerster
sponge forceps; 2 Mayo-Hegar needle
holders, 6 inch; 1 Crile-Wood needle
holder, 6 inch.

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5-2 Top pairs, left to right: 2 Army   
Navy retractors, front view and side
view; 2 Miller-Senn retractors, side
view and front view. Bottom, left to
right: 1 Mayo dissecting scissors,
straight; 1 Mayo dissecting scissors,
curved; 1 Metzenbaum dissecting
scissors, 7 inch; 1 Metzenbaum
dissecting scissors, 5 inch; 2 Goelet
retractors, front view and side view;
2 Richardson retractors, small, side
view and front view.
5-3 Left, top to bottom: 1 Metal
medicine cup; 1 weitlaner retractor,
medium. Right, top to bottom:
1 Yankauer suction tube with tip;
1 Poole abdominal suction tube with
shield; 1 Ochsner malleable retrac-
tor, medium; 1 Ochsner malleable
retractor, narrow; 1 Deaver retractor,
medium.

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CHAPTER 6

Minor Laparoscopic Set

A minor laparoscopic set is used for the placement of the trocars and a laparoscope in Additional images are available at:
preparation for the examination of the abdominal cavity. evolve.elsevier.com/Tighe/instrumentation

6-1 Left to right: 4 Crile hemo- 
static forceps, 6½ inch; 2 Péan artery
clamps, 7¼ inch; 1 Péan artery clamp,
8 inch; 2 Allis clamps, 5 × 6 teeth, 6 inch;
2 Kocher clamps, 1 × 2 teeth, 6½ inch;
1 right angle Gemini, fine curved,
8 inch; 1 Randall kidney stone forceps,
quarter curved; 1 Schroeder Braun
uterine tenaculum, 91⁄2 inch; 1 Foerster
sponge stick, straight; 1 Mayo-Hegar
needle holder, 8 inch; 1 Crile-Wood
needle holder, 6¼ inch; 2 needle
holders, 51⁄2 inch; 1 Baumgartner
serrated tungsten carbide needle
holder, 5 inch; 2 Backhaus towel
forceps.

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 6-2 Top to bottom, left to right: 1 Knife
handle, #3; 1 Mayo dissecting scissors,
straight, 6¾ inch; 1 Mayo dissecting
scissors, curved, 6¾ inch;
1 Metzenbaum scissors, curved,
7 inch; 2 Adson tissue forceps,
1 × 2 teeth, 4¾ inch; 1 tissue forceps,
1 × 2 teeth, 6¾ inch; 1 Bonney
tissue forceps, 1 × 2 teeth, 6¾ inch;
1 DeBakey-Diethrich coronary artery
tissue forceps, 6 inch; 1 Russian tissue
forceps, 6 inch; 2 Senn retractors,
sharp, 6¾ inch; 2 Army Navy retrac-
tors, double-ended; 2 Richardson
retractors, 9½ inch. Bottom, left to
right: 1 Suture passer pistol grip; 1 blue
clip; 1 fascia closure inlet trumpet.

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CHAPTER 7

Laparoscopy

Laparoscopy is visualization within the abdominal cavity. The structures have to be moved Additional images are available at:
away from the abdominal wall so the scope can be inserted safely. Pneumoperitoneum is evolve.elsevier.com/Tighe/instrumentation
accomplished by insufflation of carbon dioxide.

Laparoscopes, like arthroscopes, cystoscopes, hysteroscopes, nephroscopes, sigmoido-
scopes, sinuscopes, thoracoscopes, and urethroscopes, are types of endoscopes. Endoscopy
is the introduction of a small tube to visualize inside a body cavity or structure. The tube
(endoscope) has a lens and a light source for vision. The lens angle determines the area that
will be seen inside the patient. The most common lens angles are 0 degrees, 30 degrees, and
70 degrees.

Many of the endoscopic instruments can be used interchangeably within the various
endoscopic specialties. Interchangeable terms include obturator/trocar and cannula/port or
sleeve. The addition of instruments, either through attachments to the scope or through
another port into the cavity or structure, allows the surgeon to perform operative proce-
dures. The light source is usually a fiber optic cable, or cold light, that prevents injury to
internal structures.

Minimally invasive surgery (MIS) incorporates all the fields of endoscopic surgery
(orthopedic; genitourinary; gynecological; and ear, nose, and throat) using small incisions
or no incisions, such as when using an endoscope rather than using traditional open meth-
ods. The advantages of MIS include: (1) decreased size of the incision sites, (2) decreased
postoperative pain, (3) decreased recovery period, and (4) quicker return to work and fam-
ily. Almost all surgical specialties now perform MIS procedures on most anatomical areas.

In laparoscopy, the Mayo stand is set up to include a Bard-Parker scalpel handle #3 with
a #11 blade; 2 Backhaus towel forceps; a Verres needle for insufflation; insufflation tubing;
trocars with sleeves; a laparoscope; and a fiber optic light cable.

A brief description of the laparoscopic procedure follows:
1. The abdominal wall is elevated with 2 Backhaus towel clips.
2. A stab wound is made near the umbilicus with a Bard-Parker scalpel.
3. The Verres needle is inserted at a 45-degree angle.
4. The insufflation tubing is attached to the needle and the CO2 is insufflated to create the

pneumoperitoneum. At 12 to 15 mm Hg pressure, the needle is removed.
5. A trocar with sleeve is introduced.
6. The trocar is removed and the laparoscope is inserted.
7. The fiber optic cable is attached.

CHAPTER 7  Laparoscopy 49

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7-1 Top to bottom: Nondisposable   
laparoscopic lens: 0-degree, 5 mm;
25-degree, 5 mm; 50-degree, 5 mm;
25-degree, 10 mm; 50-degree, 10 mm.
7-2 Left to right: Camera and light
cord.

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7-3 Olympus EndoEye rigid 5-mm   
0-degree laparoscope.
7-4 Olympus EndoEye flexible 3D HD
10-mm laparoscope.

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  7-5 Kronner laparoscopic scope
holder.

7-6 Left to right: 1 Port and 1 trocar, 5 mm × 100 mm 11 mm × 100 mm 12 mm
5 mm × 100 mm, separated, then 11 mm × 100 mm Hasson
together; port and trocar together and
then separated, 11 mm × 100 mm; 1 trocar
Hasson trocar, 12 mm.

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7-7 Left to right: 1 Verres needle,     
disposable; 3 dilating-tipped trocars,
disposable, 5 mm, 10/11 mm, and
12 mm; 1 optical trocar, disposable,
10 mm; 1 blunt-tipped trocar (Hasson
type), disposable, 10 mm.
7-8 Left to right: Insufflation tubing
and insufflation tubing with battery-
operated suction/irrigator system.

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CHAPTER 8

Laparoscopic Adult MIS Set

Additional images are available at: A minimally invasive laparoscopic instrument set is used for the placement of trocars,
evolve.elsevier.com/Tighe/instrumentation laparoscope, and camera. Laparoscopic instruments are used to examine the abdominal
     ­   ­ cavity to diagnose, remove, or repair structures with small multiple incisions. Examples of
laparoscopic procedures include bowel resections, cholecystectomies, and hernia repairs.

8-1 Left to right: Nondisposable
cautery cord; instrument pan with
1 applied obturator 5 mm ×100 mm;
3 applied cannulas, 5 mm; 1 Verres
needle stylet; 1 Verres needle, me-
dium; 1 Nezhat dorsal plug; 1 applied
obturator 10 mm × 100 mm; 3 applied
cannulas, 10 mm. Bottom, in pan: 2 Red
port caps; 5 gray port caps; 1 red cap
with pinhole; 1 gray cap with 3-mm
hole; 1 male Luer-Lok adapter.

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8-2 Top, left to right: 5 Gray port caps;      
1 male Luer-Lok adapter. Bottom, left
to right: 1 Gray rubber cap with 3-mm
hole; 2 red port caps; 1 red rubber cap
with pinhole.
8-3 Top to bottom, left to right:
1 Double-action fenestrated grasper
with handle, closed; 1 double-action
aggressive grasper with handle,
open; 1 single-site surgery triport
sleeve; 1 guide to introduce triport into
abdomen; 1 active cord.

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8-4 First rack with laparoscopic
instruments that fit inside a steriliza-
tion container.
  
A

B
C
D
E
F
G

H

A BC D E F GH

8-5 Top to bottom: A, Nezhat-Dorsey L-shaped cautery with sheath below, tip (note A below has protec-
tive cover); B, needle-tip suction, tip; C, spatula cautery, tip; D, spatula suction, tip; E, L-hook cautery, tip;
F, Marlow knot pusher, tip; G, Ranfac knot pusher, tip; H, 10-mm and 5-mm Nezhat-Dorsey suction, tips.
(Tips shown below are enlarged.)

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8-6 1 Disposable ligating and dividing      
clip applier.
8-7 Top to bottom: 1 Maryland bipolar
dissector with handle; 1 Mini-Metzen-
baum scissors with handle; 1 active
cord; 1 J-hook cautery electrode;
1 Endoweave grasper with handle;
1 fenestrated single action grasper
with handle; 1 Wave grasper with
handle.

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  8-8 Second rack with laparoscopic
instruments that fit inside a steriliza-
tion container.

8-9 Tips of most of the instruments in A BC DE
the above rack: A, 10-mm Cup forceps;
B, 5-mm grasper with teeth; C, 10-mm
grasper with teeth; D, Olsen clamp;
E, double-action grasper; F, Hook
scissors; G, 5-mm Apple needle holder
with left curve; H, 5-mm Babcock
clamp grasping forceps; I, monopolar
scissors, 5 mm × 32 mm; J, Maryland
bipolar dissector.

F GH I J

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ASSISTANT ANESTHESIA CAMERA OPTIONAL
__10 HOLDER ASSISTANT
____55
VIDE(aO2ltpeornsaititoen)* SURGEON

BACK SCRUB
TABLE

VIDEO2 V1IDEO

Can be variable 
if staples = 12 mm.

* Change per physician
preference
8-10 Position for laparoscopic appendectomy and herniorrhaphy.

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CHAPTER 9

Laser Laparoscope

Additional images are available at: Laser laparoscope is using a laser beam as a precision tool for cutting, coagulating, vapor-
evolve.elsevier.com/Tighe/instrumentation izing, and welding tissue during the surgical intervention. It is very important that basic
education on the written laser policies and procedures for all personnel in the surgical envi-
9-1 Top to bottom: 1 Suction tip; ronment are mandatory within the health care facility. Policy and procedure topics should
1 medicine cup, metal. Bottom: include the following: eye protection, controlled access, fire safety, smoke (plume) evacu-
1 Bard-Parker knife handle #3; 1 ation, documentation, laser team responsibilities, skin tissue protection, electrical safety,
Adson tissue forceps with teeth education/training, and credentialing.
(1 × 2); 2 Allis tissue forceps; 1 Crile-
Wood needle holder, 7 inch; 1 Mayo­   
dissecting scissors, straight; 2 Crile
hemostatic forceps, curved; 2 Kocher
clamps; 1 Backhaus towel clip;
2 paper drape clips; 2 Senn retractors;
1 News tracheal hook.

9-2 Top to bottom: Laser laparoscope;
3 disposable ports, 2 with adapter on
side. Bottom: 1 Applied cannula, 10 mm;
disposable trocar; 1 applied cannula,
5 mm; 1 obturator, 5 mm; 1 applied
cannula, 5 mm; 1 Verres needle stylet.

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CHAPTER 10

Laparoscopic Cholecystectomy

Cholecystectomy is the surgical removal of the gallbladder by means of a laparoscope or an Additional images are available at:
abdominal incision. evolve.elsevier.com/Tighe/instrumentation

Possible equipment needed for the procedure includes a minor laparoscopic set, a
laparoscope set, and an adult minimally invasive surgery set.

A brief description of the procedure through a laparoscope, after the abdomen has been
insufflated, follows:
1. 3 or 4 trocars with sheaths are needed. There is one port for the laparoscope with camera

attached; one port for the retraction instruments; one port for dissection; and one port
for ligation.
2. Claw forceps are used to stabilize the gallbladder.
3. An Olsen clamp is used to stabilize the cystic duct during cholangiograms.
4. Metzenbaum scissors are used for dissection.
5. Ligaclip appliers are used for hemostasis.
6. An Apple needle holder is used for suture ligation.
7. A Marlow knot pusher is used for suture tightening.
8. Ligature scissors are used for cutting suture.
9. An Endo catch retriever is used for removing the specimen.
If electrosurgery is to be used, the equipment needed for the procedure includes:
1. A spatula electrode, used for hemostasis.
2. A monopolar Metzenbaum scissors, used for dissection.
3. A Maryland bipolar dissector, used for soft tissue dissection and to remove the specimen.
  ­
A 10-1 A, Endo catch retriever with the
tip closed; B, Endo catch retriever with
the tip expanded.

B

CHAPTER 10  Laparoscopic Cholecystectomy 61

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10-2 Position for laparoscopic
cholecystectomy.
­  ANESTHESIA

2V*IDEO __ VIDEO2 ELECCATURTOER- Y

ASSISTANT 5 SURGEON
5
5

__10

CAMERA
HOLDER

SCRUB

BATCAKBLE LASER OR
ELECTROCAUTERY

USED
*Video position change per physician preference

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CHAPTER 11

Laparoscopic Bowel Resection

A bowel resection is the excision of a portion of the small or large intestine and the reanas- Additional images are available at:
tomosis of it through a laparoscope or through an abdominal incision. evolve.elsevier.com/Tighe/instrumentation

Possible equipment needed for the procedure includes a minor laparoscopic set, laparo-
scope, laparoscopic camera, fiber optic light cord, and trocars.

A brief description of the procedure through a laparoscope, after the abdomen is
insufflated, follows:
1. An Endoflex retractor is used for visualization.
2. A Hunter (Glassman) bowel grasper is used for handling the bowel.
3. A Maryland bipolar dissector is used for freeing up the bowel.
4. A Nezhat suction/irrigator is used for lubrication and removal of fluid.
5. A linear stapling device is used for transecting the bowel.
6. A Ligaclip applier is used for hemostasis.
7. A needlepoint suture passer is used in suturing.
8. A Marlow knot pusher is used for suture tightening.
9. A linear stapling device is used for reanastomosis of the bowel.
  ­   ­
11-1 Applied Medical Alexis
protractor 5 to 9 cm.

11-2 Top to bottom: 1 Endoflex
protective cover; 1 Endoflex retractor,
triangle, 5 mm, 80-mm length; 1 biopsy
forceps, 5 mm, and tip.

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    11-3 FastClamp with Endoflex snake
retractor. Top to bottom: 1 Table bar;
1 table attachment; 1 Endoflex
snake retractor (in coiled position);
1 supporting arm (attached to snake
retractor).

11-4 Top to bottom: 1 EEA anvil
grasper and 1 esophageal retractor.

11-5 Top to bottom: These are extra
long instruments; 1 Hunter (Glassman)
bowel grasper, 5 mm, 45-cm length;
1 Nezhat suction/irrigator, 5 mm,
45-cm length; 1 Maryland bipolar
dissector, monopolar, 5 mm, 45-cm
length.

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AB C 11-6 Left to right: Tips: A, Hunter
(Glassman) bowel grasper, 5 mm, 45-cm
­       length; B, Nezhat suction/irrigator,
5 mm, 45-cm length; C, Maryland bipo-
lar dissector, 5 mm, 45-cm length.

11-7 1 Laparoscopic ligating and
dividing disposable clip applier.

11-8 1 Linear cutter with reloadable
head.

A 11-9 A, 1 Ethicon SecureStrap
laparoscopic tacker. B, SecureStrap
tack.

B

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  11-10 A, Ethicon Echelon Flex A
60 Endo GIA power stapler.
B, Endo GIA power stapler tip.

B

11-11 Top to bottom: 1 Contour
curved cutter; 1 proximate linear
stapler, 60 mm; 1 proximate linear
stapler, 90 mm.

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11-12 1 Ethicon endoscopic curved     
intraluminal stapler ECS33.

11-13 Top to bottom: 1 Covidien
Endoscopic 60 Endo GIA tri-stapler,
power and 1 radial attachment.
11-14 Endo GIA stapler with universal
handle and tip with staples.

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11-15 A, Top to bottom: 1 Ethicon     A B
Laparoscopic Enseal, 5 mm 35 cm; B
1 Ethicon Laparoscopic Harmonic
scalpel, 5 mm 23 cm. B, Enlarged tip: ANESTHESIA
Ethicon Laparoscopic Enseal, 5 mm.

11-16 A, Top to bottom: 1 Covidien A
Sonicision cordless ultrasonic dissec-
tion, 5 mm, 39 cm with tightening key.
B, Enlarged tip: Covidien Sonicision
cordless ultrasonic dissection.

11-17 Position for laparoscopic
bowel resection.

CAMERA ASSISTANT
HOLDERVIDEO1

SURGEON __5__5
__5
__10

SCRUB 5, 10, or 12 mm
VARIABLE; DEPENDS

ON SURGERY

2V*IDEO

68 UNIT 2  General Surgery BACK
TABLE
* Video position change per physician preference
REVERSE FOR RIGHT SIDE
PATIENT IN LOW ALLEN STIRRUPS

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CHAPTER 12

Bowel Resection

Possible equipment needed for a bowel resection includes a basic laparotomy set and a Additional images are available at:
self-retaining retractor. evolve.elsevier.com/Tighe/instrumentation

A brief description of the procedure, doing the surgery through an abdominal incision,
includes:
1. A self-retaining retractor is used for visualization after the abdomen is opened.
2. A Doyen intestinal forceps is used for atraumatic bowel clamping.
3. A Carmalt hemostatic forceps is used for hemostasis and blunt dissection.
4. A long Babcock clamp tissue forceps is used for handling the bowel.
5. An Ethicon linear cutter is used for dissection of the bowel.
6. An Ethicon linear stapler is used for reanastomosis of the bowel.

Resection of the sigmoid colon may need a special stapling device (EEA) that also cuts
the tissue.
 ­ ­
12-1 Left to right: 2 DeBakey vascular
atraugrip tissue forceps, short;
2 Doyen intestinal forceps, straight;
2 Doyen intestinal forceps, curved;
12 Halsted mosquito hemostatic
forceps, curved; 4 Carmalt hemostatic
forceps, long, curved; 6 Carmalt hemo-
static forceps, long, straight.

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  12-2 Left to right: Tips: A, Doyen A B
intestinal forceps, straight and curved;
B, Carmalt hemostatic forceps, long,
curved, and straight.

12-3 Top to bottom: 1 Ethicon stapler
PPH (utilized for prolapse rectal
hemorrhoid tissue) and attachment;
1 Covidien purse string, disposable.

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CHAPTER 13

Sigmoidoscopy

A sigmoidoscopy is the visualization within the sigmoid and descending colon with the aid Additional images are available at:
of a scope and a light source. Also used is a laparoscopic sigmoid colectomy to check the evolve.elsevier.com/Tighe/instrumentation
anastomosis after stapling.

A brief description of the procedure follows:
1. The scope is inserted with the obturator in place.
2. The obturator is removed.
3. The air hose and bulb are attached to the scope.
4. The colon is inflated.
5. The light source is attached to the scope.
 
13-1 Welch Allyn operative sigmoido-
scope. Left to right: 1 Fiber optic cord;
1 light handle; 1 obturator; 1 disposable
sigmoidoscope; 1 colonic insufflator.

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CHAPTER 14

Laparoscopic Bariatric Surgery

Additional images are available at: Bariatrics is the field of medicine that deals with obesity and weight-related conditions.
evolve.elsevier.com/Tighe/instrumentation Laparoscopic surgery decreases the surgical incision on individuals that may be obese and
have impaired healing. Bariatric instruments are the same as basic laparoscopic instruments
  except they are longer and may be wider to accommodate a patient’s larger size. Possible
equipment needed for laparoscopic bariatric surgery includes laparoscopic instrumenta-
tion, trocars, and obturators that are longer in length.

A brief description of the procedure follows:
1. The laparoscope is inserted in the usual manner.
2. The Nathanson retractor is positioned to retract the liver.
3. Depending on the scheduled surgery, various types of instrumentation may be used.
4. To assist closure, a fascia closure device may be used.

14-1 Left to right: 1 Bard-Parker knife
handle #3; 2 Adson tissue forceps with
teeth (1 × 2); 2 thumb tissue forceps
without teeth, short; 1 Mayo dissect-
ing scissors, curved; 1 Metzenbaum
dissecting scissors, 7 inch; 1 Mayo
dissecting scissors, straight; 2 Mayo-
Péan hemostatic forceps, curved;
2 Kocher clamps; 1 Crile-Wood needle
holder, 7 inch; 1 Crile-Wood needle
holder, 5 inch; 6 Crile hemostatic
forceps, curved, 6½ inch; 4 Backhaus
towel clips; 8 paper drape clips;
3 noninsulated rotating handles.

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14-2 Two baby Deaver retractors. ­   
14-3 Left to right: 2 Sets of trocars
and obturators, 1 set 5 mm × 100
mm (standard), 1 set 5 mm × 150
mm (bariatric); 2 sets of trocars and
obturators, 1 set 11 mm × 150 mm
(bariatric), 1 set 12 mm × 150 mm
(bariatric); 1 set Hasson trocar and
obturator, 12 mm.

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14-4 Left to right: Disposable high-   
flow insufflation tube and InsuFlow
heater hydrator insufflation tubing.
14-5 Top to bottom: 1 Bariatric
telescope, 10 mm, 30 degrees; 3 tele-
scopes, 45, 30, and 0 degrees;
1 telescope, 5 mm, 30 degrees.

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14-6 Nathanson retractor with lapa-   
roscopic Thompson retractor holder.
14-7 Top: 2 Apple needle holders
with locks, 5 mm, right and left curves.
Bottom, left to right: 1 Inlet fascia
closure device; 1 cone, long; 2 medicine
cups, metal, side view and top view;
1 Nathanson liver retractor.

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  14-8 A, Top to bottom: 1 Harmonic A
scalpel 5 mm, 23 cm; 1 Harmonic cord
and 1 tightening key. B, Enlarged tip:
Harmonic scalpel 5 mm with curved
shears.

B

14-9 Rack with laparoscopic instru-
ments that fits inside a sterilization
container.

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14-10 Top to bottom: 1 Switchblade     
scissors, bariatric; 1 switchblade
scissors, regular; 1 bariatric spatula; 1
Nezhat-Dorsey irrigator.
14-11 Top and bottom instruments
work together: bottom: fenestrated
bowel grasper that slides inside the
noninsulated sheath at the top; both
connect to the noninsulated metal
handle; middle: DeBakey tissue for-
ceps, 10 mm, curved.
14-12 Three Hunter (Glassman)
bowel graspers.

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14-13 Tips of Hunter (Glassman) bowel  A B
grasper, 5 mm: A, Closed; B, open.

14-14 A, 3 Apple needle holders, 2 A
left curved, 1 right curved. B, 5-mm
Apple needle holder with left curve.

B

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CHAPTER 15

The da Vinci ® Surgical System and EndoWrist ®
Instruments (Robotic Instruments)

EndoWrist instruments are manufactured by Intuitive Surgical, Inc. specifically for use with Additional images are available at:
the da Vinci Surgical System. The EndoWrist instruments provide surgeons with natural evolve.elsevier.com/Tighe/instrumentation
dexterity and a full range of motion for more precise operation through tiny incisions. Simi-
lar to the human wrist, an EndoWrist instrument allows for rapid and precise suturing, dis-
section, and tissue manipulation.

The EndoWrist instrument line features a variety of specialized tip designs, including
forceps, needle drivers, and scissors; monopolar and bipolar electrocautery instruments;
scalpels, and more. The EndoWrist instruments are available in 5-mm and 8-mm diameters
to meet surgeons’ requirements.

After an EndoWrist instrument is installed on the da Vinci System, the interface is
designed to recognize the type and function of the instrument and to display the number
of uses available. This interface allows the da Vinci System to detect when an instrument
needs replacement.

Because of the delicate nature of these instruments, all handling, cleaning, and steriliza-
tion must be performed in strict accordance with the manufacturer’s guidelines. Intuitive
Surgical, Inc. has training courses available to assist with education.

A B 15-1 Snap-fit scalpel instruments,
shown with Snap-fit: A, 15-Degree
blue blade; B, paddle blade. (Courtesy­   
Intuitive Surgical, Inc., Sunnyvale,
Calif.)

A B C 15-2 Scissors: A, Potts scissors;
B, round tip scissors; C, curved
scissors. (Courtesy Intuitive Surgical,
Inc., Sunnyvale, Calif.)

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A B CD

E F GH

I J KL

  15-3 Forceps/graspers: A, DeBakey forceps; B, Cadiere forceps; C, Resano forceps; D, double-fenestrated
grasper; E, Cobra grasper; F, long tip forceps; G, ProGrasp forceps; H, tenaculum forceps; I, thoracic
grasper; J, fine tissue forceps; K, Graptor (grasping retractor); L, black diamond microforceps. (Courtesy
Intuitive Surgical, Inc., Sunnyvale, Calif.)

15-4 EndoWrist monopolar cautery A B C
instruments: A, Hot Shears, also called
monopolar curved scissors; B, per-
manent cautery hook; C, permanent
cautery spatula. (Courtesy Intuitive
Surgical, Inc., Sunnyvale, Calif.)

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A B C 15-5 EndoWrist bipolar instruments:
A, PreCise bipolar forceps; B, Mary-
land bipolar forceps; C, fenestrated­     
bipolar forceps; D, PK® dissecting
forceps; E, microbipolar forceps.
(Courtesy Intuitive Surgical, Inc.,
Sunnyvale, Calif.)

DE

15-6 Harmonic® curved shears.
(Courtesy of Intuitive Surgical, Inc.,
Sunnyvale, Calif.)

A B 15-7 EndoWrist needle drivers:
A, Large needle driver; B, large
SutureCut needle driver; C, Mega
needle driver; D, Mega SutureCut
needle driver. (Courtesy Intuitive
Surgical, Inc., Sunnyvale, Calif.)

CD

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15-8 Specialty instruments: A, Atrial A B C
retractor; B, atrial retractor short right;
  ­  ­   C, dual blade retractor; D, EndoPass
delivery instrument; E, cardiac probe
grasper; F, valve hook; G, pericardial
dissector. (Courtesy Intuitive Surgical,
Inc., Sunnyvale, Calif.)

DE F

G

15-9 EndoWrist clip appliers: A, AB
Small clip applier; B, large Hem- AB
o-lok® clip applier. (Courtesy Intuitive
Surgical, Inc., Sunnyvale, Calif.)
15-10 EndoWrist 5-mm instruments
(graspers): A, Schertel grasper, 5 mm;
B, bowel grasper, 5 mm. (Courtesy
Intuitive Surgical, Inc., Sunnyvale,
Calif.)

15-11 EndoWrist stabilizer shown
with tubing. (Courtesy Intuitive Surgi-
cal, Inc., Sunnyvale, Calif.)

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 15-12 da Vinci Si HD Surgical Systems. Left to right: Two surgeons’ consoles (power cables do not
show on this photo); nurse at the operating table by Mayo stand in surgical attire and in front of patient
cart, with a vision cart to her right. During an operation, you would see an assistant to the surgeon at the
patient’s cart with the scrub nurse (photographed on the right), an anesthesiologist at his or her machine,
a circulating nurse, and the surgeon or surgeons in an anteroom next to the operating room where the
patient is being operated upon. In most situations the da Vinci Si HD Surgical Systems are located within
the operating room, and the surgeons are wearing proper operating room attire, including head covers
and masks. (Courtesy Intuitive Surgical, Inc., Sunnyvale, Calif.)

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CHAPTER 16

Breast Biopsy/Lumpectomy

Additional images are available at: A breast biopsy is the removal of suspicious breast tissue for the purpose of microscopic
evolve.elsevier.com/Tighe/instrumentation examination.

  A brief description of the procedure follows:
1. A Halsted mosquito forceps is used for hemostasis.
2. A DeBakey tissue forceps is used for atraumatic handling of breast tissue.
3. A Lahey thyroid tenaculum is used for grasping the pathology.
4. A Senn retractor is used for deeper retraction.
5. Joseph hooks are used for skin retraction.

16-1 Top, left to right: 1 Medicine
cup, metal; 2 Army Navy retractors,
front view and side view. Bottom, left
to right: 2 Bard-Parker knife handles
#3; 1 Adson tissue forceps (1 × 2);
1 Brown-Adson tissue forceps (9 × 9);
2 DeBakey vascular atraugrip tissue
forceps, short (front view and side
view); 2 paper drape clips; 4 Halsted
mosquito hemostatic forceps, curved;
2 Crile hemostatic forceps, 5½ inch;
2 Allis tissue forceps; 2 Lahey goiter
vulsellum forceps; 1 Crile-Wood
needle holder, 6 inch; 2 Mayo dissect-
ing scissors, straight and curved;
1 Metzenbaum dissecting scissors,
5 inch; 2 Joseph skin hooks, double;
2 Miller-Senn retractors, side view
and front view.

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