Handling of Basic Surgical Instruments in the Operating Theater

 

Instrument handling is a critical part of surgical procedures. Proper technique can minimize the risk of injury to the worker and damage to the instrument. Here are some tips for safe handling of Operating room instruments:

Angles

 Proficiency in various angles is crucial for the operating team to enhance the utilization of instruments. These angles include:

Manipulation Angle:

The angle created between two instruments converging at the operative field.

Optimal Range: An effective manipulation angle falls around 60° (45-75°).

Elevation Angle:

The angle formed by the shaft of an instrument concerning the horizontal axis of the patient.

Ideal Range: The recommended elevation angle is 30-60°.

Azimuth Angle:

The angle formed between the laparoscope shaft and an instrument.

Ideal Consistency: The azimuth angle should ideally be consistent for all instruments.

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Safe handling

Basic instruments like needles, blades and forceps also have safe handling procedures.

Blade

The removal of the blade should not be done with fingers but with a blade remover or forceps. The blade is placed with a clamp or needle driver on a scalpel holder and multiple grips are possible according to the desired type of incision.

Suture

In laparoscopic suturing, the suture is grasped so that the needle can 'flop' when introduced through a port. If the needle is directly grasped instead, there is likely going to be a tear in the lining of the cannula and, potentially, the abdominal wall tissues and internal structures.

Needle

The needle is usually held near its midpoint in a perpendicular manner in the tip of the jaws. A needle can be placed in a needle holder in different ways based on the desired way of stitching.

Forceps

More force can be applied when the forceps is held at its tip.

Scissors

The thumb and either ring finger or middle finger are placed in the holes. It is important to have sufficient pressure on the blades by putting the correct force on both finger rings.

Triangulation

In laparoscopic surgery, the principle of triangulation is utilized. This is when the viewing trocar and laparoscope are placed in the centre with working ports placed equidistant at either side to form a triangle. This arrangement allows the surgeon to have a central view of the target structure, optimal instrument manipulation angles, helps the depth perception, camera orientation and surgical ergonomics.

Sectorization

Like triangulation, sectorization is another way of organizing an operative field. It involves placing the working trocars to one side of the viewing trocar.