Surgical instruments are specialized tools designed to perform specific actions during an operation, such as cutting tissue, controlling bleeding, or holding structures apart. Every instrument used in the operating theatre has a distinct purpose and is manufactured from high-grade metals like stainless steel, titanium, or vitallium to withstand repeated sterilization. Understanding the anatomy of an instrument—including the tips, jaws, box lock, shanks, and ratchets—is essential for safe handling and proper functioning during procedures.
Surgical instruments are categorized into functional groups based on their primary use during an operation. This classification helps scrub nurses anticipate the surgeon's needs and organize the instrument table efficiently.
Cutting and dissecting instruments feature sharp edges or blades used to incise skin, subcutaneous tissue, organs, and other bodily structures. Scalpels, operating scissors, bone cutters, and saws fall under this category. Scalpels typically consist of a reusable handle and a disposable blade, which must always be attached and removed using a needle holder or instrument rather than bare fingers to prevent sharps injuries.
Grasping and holding instruments are designed to manipulate tissues, hold sterile drapes, or manage needles. They can be traumatic (with teeth, like Kocher forceps) or atraumatic (smooth jaws, like Babcock forceps). Tissue forceps (tootheth pickups) and thumb forceps are also part of this group, allowing the surgeon to hold delicate structures without causing excessive crushing injury.
Retracting and exposing instruments are essential for holding back wound edges, organs, or tissues to provide a clear view of the operative field. They are available in two main forms: manual hand-held retractors (such as Senn, Richardson, and Deaver retractors) and self-retaining retractors (such as Gelpi or Balfour retractors) which stay open on their own through a ratchet or screw mechanism.
Clamping and occluding instruments are designed to compress blood vessels or hollow organs to control bleeding and prevent spillage of contents. Hemostatic forceps, such as Crile, Kelly, and Mosquito clamps, feature locking ratchets and grooved jaws. The nurse must hand these instruments securely to the surgeon, usually orienting the ring handles toward the surgeon's palm for immediate use.
Suturing and stapling instruments are used to close wounds and approximate tissues at the end of or during a procedure. Needle holders (such as Hegar needle holders) securely grasp suture needles, while surgical staplers rapidly apply metal clips or staples to skin, bowel, or vascular structures. Proper loading of the needle holder—usually one-third to one-half the distance from the swaged end of the needle—prevents bending and ensures precise placement.
Proper maintenance and sterilization prolong the lifespan of surgical instruments and protect patients from healthcare-associated infections. Instruments must be rinsed of gross blood and debris immediately after use, cleaned with enzymatic detergents, and inspected for defects like loose box locks or dull blades. Packaging must allow sterilizing agents like steam or ethylene oxide to penetrate effectively, and items must be stored in clean, dry environments.