Surgical instruments - a set of instruments used for surgical manipulations in the dressing room and in the operating room, as well as for diagnostic examinations. There are general surgical and special ones - obstetric and gynecological (see Obstetric and gynecological instruments), neurosurgical, otorhinolaryngological, ophthalmological, traumatological and orthopedic, urological instruments, etc. X. and. include products of various designs, starting with tools consisting of one part (scalpel, spatula), and ending with mechanized tools with manual, electric and pneumatic drives (several thousand items of different types of tools).

Surgical instruments are divided according to functional purpose: 1) cutting (for cutting tissue, opening abscesses, resection of various organs, excision of tumors, cutting off growths, polyps, etc.) - medical chisels, medical spoons, surgical knives, medical scissors, raspatory, bone forceps and wire cutters, etc.; 2) piercing (for punctures for the purpose of introducing medicinal solutions, threads for stitching, tubes, drainages, etc.); 3) clamping (for stopping bleeding, clamping tubular and hollow organs during their resection, holding and fixing tissues, organs or surgical needles) - hemostatic clamps, for temporary clamping of blood vessels, fixation, gastrointestinal, needle holders, tweezers, etc.; 4) expanding and pushing back (to expand wounds, cavities, passages and push back organs so as not to cause accidental injuries during operations); 5) probing and bougienage - to study narrow passages and increase their clearance (see Bougienage, Probing).

H. and. They are made from chromium, stainless steels, titanium alloys, and less often from silver, gold, and platinum. Instruments can consist of one part (probe, scalpel) or be complex devices with manual, electric, or pneumatic drive.

H.i. , used for the operation, are divided into 2 groups:
1) General instruments, which are used in almost all operations (cutting instruments, auxiliary instruments, hemostatic clamps, instruments for connecting tissues).
2) Special instruments used for certain types of operations (bone, urological, tracheostomy, etc.).

Here are the most commonly used tools:

Tools for separating tissue
Pointed scalpel

A puncture or incision is made with a pointed scalpel.

Abdominal scalpel

Using an abdominal scalpel, linear incisions and tissue preparation are made.

Amputation knife

Designed for cutting soft tissues during limb amputations.

Surgical scissors
Pointed straight

Blunt curved

Designed for removing sutures and cutting ligatures:
- pointed
- blunt-ended
- straight
- curved

Dressing scissors(button)

To remove bandages

Trocar

Used for puncture of cavities (abdominal, less often pleural)

Clamping tools (grasping)
Hemostatic clamps
Kochera (straight)

Billroth (curved)

Mosquito


Purpose - temporary and final stop of bleeding during surgery.

Mikulicz clamp

Used in operations on organs abdominal cavity to capture the pariental peritoneum and fix it.

Intestinal pulp
Elastic splint

Crush pulp


To block the lumen of hollow organs during resection of the latter.

Hemorrhoidal fenestrated clamp

Used to remove hemorrhoids.

Linen tacks

Used to attach surgical linen to the edges of the wound

Corsage straight


It is used for feeding instruments and for processing the surgical field (splints).

Language supporter

Used during inhalation anesthesia.

Tweezers
Anatomical

Surgical

Palmate

Instruments for widening wounds
Two-, three-, four-prong hooks

- pointed
- blunt-ended

Farabeuf C-hook

Used for operations on soft tissues and cavities.

Mirrors
Hepatic

Abdominal

Renal

Pulmonary

Used for operations on the abdominal and thoracic cavity

Lock retractors
According to Mikulic

Note during laparotomy.

According to Gosse

Note with thoracotomy.

Tools for enlarging natural holes

Gag

Rectal speculum

Tools to protect fabrics from damage
Probes
Buttoned


To study cavities, what is the depth of the wound.
Grooved


For cutting tissue without damaging underlying tissue.
Combined
Buttoned + grooved.

Probes are used during primary surgical treatment of a wound (PST), to examine the edges, bottom, and walls of the wound.

Retractor


Note when amputating a limb to protect soft tissues when sawing bone.

Reverden blade

Note to protect the abdominal organs during dissection of the peritoneum. During obdominal surgery.

Special instruments for tracheostomy
Trousseau tracheal dilator

Single-tooth hook for lifting the tracheal ring

Tracheostomy tube

Instruments for bone operations
Raspator
Farabeuf Raspatory

5.1. GENERAL AND SPECIAL SURGICAL

TOOLS

There are currently enough a large number of classifications medical instruments and options for dividing it into groups. By purpose, surgical and dental instruments can be distinguished.

Surgical instruments are divided into two groups.

General surgical instruments- these are the instruments most often used in the clinic and used for basic manipulations. Quite often these tools are multifunctional.

Special tools- these are instruments that are used only in certain areas of surgery. Quite often, the tools of this group are used only when performing a specific stage of any one operation.

General surgical instruments, in turn, can be divided into 4 subgroups depending on their specific purpose:

tools for separating tissues: scalpels, knives, scissors, osteotomes, chisels, wire cutters, etc.;

tools to stop bleeding: Cooper and Deschamps ligature needles, hemostatic clamps, clips and clamps for their application;

tools for joining fabrics: needle holders, surgical needles, tweezers for applying Michel brackets, staplers, instruments for bone sutures, etc.;

auxiliary tools:

To create an exhibition: retractors, hooks, mirrors, etc.;

For holding and displacing organs: tweezers, lifters, probes, etc.

According to the number of component parts, instruments can be divided into single-piece (usually solid forged or stamped) - scalpels, chisels, chisels, hooks, as well as prefabricated ones, which, in turn, can be hingeless (tweezers, trocars) and hinged (clamps, needle holders, forceps). The last group is classified by the number of joints: single-jointed (clamps, scissors, most forceps) and multi-jointed (double-gear pliers, gastric sponges).

In addition, according to technical specifications(GOST 19126-79), surgical instruments are divided into:

Tools with sharp sharpening (sharp, cutting, piercing);

Tools with spring properties (cracks, hingeless);

Plate tools (hooks);

Wire instruments (probes, some types of hooks, conductors);

Tubular instruments.

This division can be transferred to special tools.

Dental instruments, among other things, are divided into:

Tools general purpose(dental burs, dental mirror, tweezers, scissors, probes);

Therapeutic instruments (for fillings, treatment of periodontal diseases, etc. - smoothers, curettes, needle files, hooks);

Surgical instruments (for tooth extraction, treatment of periostitis, etc. - forceps, curettage spoons, elevators);

Instrumentation for endodontics.

All dental and general surgical instrument arias are combined into special sets according to the final purpose, for example, a set for tooth extraction (a separately similar, smaller set for tooth extraction in children), an examination set, a set for endodontics, a set for filling, etc. The composition of the kits varies somewhat depending on the medical institution, supplier, manufacturer, etc. Sometimes the formation of a set is also influenced by the habit of the dentist himself. In this regard, it is advisable to highlight basic part of the set and additional.

It is quite natural that a basic set of tools should be of particular interest to a student.

The mandatory set of general surgical and special instruments is reflected in the “Appendix?” 9" to the order of the Ministry of Health and Social Development of the Russian Federation dated April 14, 2006? 289 “On measures to further improve dental care for children in the Russian Federation.”

5.2. TYPES OF SURGICAL INSTRUMENTS

5.2.1. Tools for separating tissue

Scalpel- a small one-piece tool with a short blade and a long handle (Fig. 5.1). Designed for cutting soft tissues (skin, subcutaneous tissue, aponeuroses, muscles, etc.). There are several types of scalpels: pointed, abdominal, ophthalmic. The latter differs only in its smaller size and, as a rule, is made of the pointed type. The use of a scalpel depends on the shape of its blade: an abdominal scalpel is used to cut the skin, a pointed scalpel is used for more subtle manipulations, when, in addition to the incision, it is also necessary to make a puncture. An eye scalpel is used to make small cuts. There are modifications of the scalpel with replaceable blades. Currently, disposable scalpels are becoming increasingly common. For particularly thin cuts on the face

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Rice. 5.1.Scalpels: 1 - abdominal scalpel; 2 - pointed scalpel; 3 - ophthalmic scalpel; 4 - disposable scalpel; 5 - blade holder

Rice. 5.2. Scissors:

1 - blunt scissors; 2 - pointed scissors; 3 - Richter scissors; 4 - scissors, curved along a plane (Cooper); 5 - eye scissors; 6 - vascular scissors

(for example, when plastic surgery) also use a microsurgical instrument - a blade holder. The cutting part of this tool is represented by a fragment of a razor blade, which allows, firstly, to make thinner and more accurate cuts, and secondly, to quickly replace the blade if necessary.

Scissorsare a prefabricated tool. They consist of a working part (blades) and handles connected with a screw or rivet (Fig. 5.2). The edges of the blades, closing, ensure cutting of tissue. Scissors can be straight, curved or angled. In addition, there are blunt and pointed scissors. Small scissors, both straight and curved, are called eye scissors. The use of scissors depends on their shape, since scissors, in addition to cutting, also produce unwanted crushing of tissue. They are used where for some reason it is impossible to use a scalpel (for example, when cutting loose tissues or when it is necessary to make an incision to a certain depth without affecting the underlying layers). It is typical to use straight and curved scissors to form a patch from a filmy plastic material (fascia, greater omentum, synthetic film).

Angled scissors (Richter scissors) are usually used to cut the peritoneum and pleura during laparotomy and thoracotomy, as well as to cut the hernial sac. There are also modifications of scissors for cutting gauze (with a thickened cutting part), plaster (with a beak at one end) bandages, as well as for longitudinal dissection of blood vessels. Gradually acquire wide application microsurgical scissors.

ChiselsAnd chisels are solid forged or stamped one-piece tools (Fig. 5.3). They consist of a pointed working part (straight or curved) and a handle. The chisel is characterized by a straight handle of a simple shape with a flattening at the end (“heel”, or striking part). The chisel has a massive, hollow inside handle without flattening. These instruments are intended for processing bone: with a chisel you can scrape off excess bone tissue (during osteosynthesis or plastic surgery), and with the help of a chisel and a hammer, the surgeon dissects or incises the bone. The largest and strongest chisels are also called osteotomes.

Bone spoons- one-piece instruments with a working part made in the form of a small spoon with pointed edges (see Fig. 5.3). Used to remove bone remnants during treatment

Rice. 5.3.Instruments for bone operations

Chisels and chisels: 1 - grooved chisel; 2 - straight chisel; 3 - Vojaček’s chisel, grooved; 4 - osteotome. Bone spoons: 5 - Volkmann spoon; 6 - Bruns spoon; 7 - dental excavator. Raspators: 8 - Farabeuf straight raspator; 9 - Farabeuf curved raspator

comminuted fractures or osteomyelitis. In addition to bone trays, dental excavators are used in dentistry, which are designed to remove temporary fillings, remove sequesters, clean the tooth cavity, etc.

Raspatorydesigned to remove periosteum from bones (see Fig. 5.3). Consist of a working part - a cutting edge with support platform and a durable handle. The shape can be straight or curved.

Bone forcepsused for biting bone fragments - when treating wounds of the brain and facial parts of the head (Fig. 5.4). Luer forceps are distinguished by a rounded working part with a cavity inside into which the bitten bone fragment is placed. Liston's pliers are made like side cutters and provide a relatively thin and straight cutting line. To increase the cutting torque, a double gear is installed in the pliers. Dahlgren pliers are distinguished by the fact that their cutting part is made in the form of a hook and can be replaced if broken or worn out. These forceps are used for trephination of the bones of the cranial vault.

Rice. 5.4. Bone forceps:

1 - Liston pliers; 2 - curved Luer pliers; 3 - appearance of the double transmission of pliers; 4 - Dahlgren cutters

Tooth extraction forceps: each tooth corresponds to very specific forceps, differing in numbers (Fig. 5.5).

Elevatorsdental - designed to remove remnants of tooth roots.

5.2.2. Tools to stop bleeding

Mainly used to stop bleeding various types hemostatic clamps (Fig. 5.6).

Hemostatic clamp consists of a handle with a ratchet and a working part. In this case, the shape and dimensions of the working part may be different. According to the shape of the working part, straight clamps are distinguished

Rice. 5.5.Tooth extraction forceps (from: Bezak V.I., 1969): 1 - straight? 2 - for removing incisors, canines and premolars; 2 - S-shaped M7 - for removing premolars; 3 - beak-shaped with converging cheeks? 13 - for removing roots; 4 - S-shaped? 17 - for removing right molars; 5- S-shaped? 18 - for removing left molars; 6 - beak-shaped (crown)? 22 - for removing molars on both sides; 7 - beak-shaped with rounded, non-converging cheeks? 33 - for removing teeth and roots; 8 - bayonet-shaped? 67 - for removing wisdom teeth; 9 - beak-shaped horizontal? 79 - for removing wisdom teeth with difficulty opening the mouth; 10 - bayonet-shaped (bayonet) with narrow cheeks? 51a - for removing roots and teeth with a destroyed crown; 11 - bayonet-shaped (bayonet) with medium cheeks? 51 - for removing roots and teeth with a damaged crown; 12 - bayonet-shaped (bayonet) with wide cheeks? 52 - for removing roots and teeth with a damaged crown

Rice. 5.6.Tools to stop bleeding. Hemostatic clamps: 1 - straight Billroth clamp; 2 - straight Kocher clamp; 3 - “mosquito” type clamp; 4 - Hoepfner vascular clamp. Ligature needles: 5 - Deshana ligature needle; 6 - Cooper ligature needle

and curved. More convenient are curved clamps, which are applied to the stump of the isolated and transected vessel and do not impair the view of the wound. A Hoepfner vascular clamp can be used to suturing a damaged carotid artery using the end-to-end method.

Ligature needlesused for ligating the vessel along its length (see Fig. 5.6). In maxillofacial surgery they are used for ligation of the carotid arteries and their branches. The tip of the needle can be sharp or blunt. In this case, the Cooper needle is used to ligate a deep-lying vessel, and the Deschamps needle is used for a superficial vessel.

5.2.3. Tools for joining fabrics

Needle holdersThe shape closely resembles hemostatic clamps, but differs in a thicker and shorter working part. Designed to hold surgical needles

Rice. 5.7. Needle holders:

1 - Hegar needle holder; 2 - Troyanov needle holder; 3 - Mathieu needle holder; 4 - microsurgical needle holder

Rice. 5.8.Surgical needles:

a - surgical needles different sizes. b - cross-section of piercing needles; c - cross-section of cutting needles; d - atraumatic needle with thread

in the process of suturing soft tissues. To work with thin suture material and small needles, microsurgical needle holders are used (Fig. 5.7).

Surgical needles designed for suturing fabrics (Fig. 5.8). According to their shape, needles are divided into straight and curved. According to the cross section, there are piercing (round cross-section) and cutting (triangular, rectangular, trapezoidal). By size, needles are divided into 12 groups by length (numbers from 1 to 12, the larger the number, the smaller the needle) and 3 groups by thickness (thick, thin, eye). In addition, a separate group consists of atraumatic needles, in the back of which sterile suture material is attached.

5.2.4. Auxiliary Tools

Hookscan be one-sided or two-sided (Fig. 5.9). Single-sided hooks consist of a handle and a working part. An example of these are the three-prong and four-prong Volkmann surgical hooks. The double-sided hook (Farabefa) is more versatile, as it has two working parts of different sizes. In addition, it causes less trauma to the retained tissues. The Farabeuf hook can be made in two versions - C-shaped and S-shaped. The saddle hook is used to hold the isthmus of the thyroid gland during operations on it and the trachea. The Limberg hook is used in the treatment of zygomatic arch fractures.

Gag (Fig. 5.10) is intended for forced opening of the mouth in emergency conditions, some

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Rice. 5.9. Hooks:

1 - four-prong Volkmann hook;

2 - Farabefa plate hook;

3 - small saddle hook

Rice. 5.10.Mouth dilators and retractors:

1 - screw mouth opener; 2 - ratchet mouth opener; 3 - screw retractor; 4 - tongue holder

modifications are used in a number of clinics for any interventions in the oral cavity.

Retractors (see Fig. 5.10) are used to expand the edges of the surgical wound. In maxillofacial surgery, small wound retractors with a screw traction, for example, the Edson retractor, are widely used.

Language supporter(see Fig. 5.10) is used to capture the tongue and displace it during oral surgery.

Tweezers- two-piece tools with springy working parts (Fig. 5.11). Designed to capture and hold tissues, organs, and dressings. Anatomical tweezers have a more gentle, but at the same time less strong grip - they hold

Rice. 5.11.Tweezers and forceps:

1 - anatomical tweezers; 2 - surgical tweezers; 3 - dental tweezers; 4 - eye tweezers; 5 - forceps

easily injured anatomical formations. Surgical tweezers have teeth on the working surface that injure tissue, but grip them very firmly. Dental tweezers are curved, they are convenient for working during the treatment of dental diseases - they are used to insert turundas into the carious cavity. Eye tweezers are smaller in size and can be used for minor manipulations.

Forcepsvary in size (large, medium, small) (see Fig. 5.11). The shape can be straight or curved. By appearance resemble hemostatic clamps, but have a stronger working part with a thickening at the end. They are designed to capture sterile linen, suture material, and instruments from sterilizers. Quite often, curved forceps are used during primary surgical treatment of wounds for their mechanical cleaning.

Rice. 5.12. Spatulas and probes:

1 - neurosurgical spatula; 2 - therapeutic spatula; 3 - dental spatula; 4 - button-shaped probe; 5 - grooved probe; 6 - Kocher goiter probe; 7 - bayonet-shaped dental probe; 8 - dental excavator

Spatulas- instruments with a flattened and blunted working part (Fig. 5.12). Neurosurgical spatulas are used to push back brain tissue during neurosurgical procedures. A therapeutic spatula is needed to move it towards the tongue when examining the oral cavity and the condition of the tonsils. Dental spatulas are mainly used for mixing filling paste.

Probes(see Fig. 5.12). The main purpose of the button probe is the revision of fistula tracts. A grooved probe is used when cutting the fascia or aponeurosis to protect the underlying tissue from damage. The Kocher probe is used similarly to ligature needles during operations on the thyroid gland. Dental

probes are used for dental inspection - identifying softening of dentin, depth of carious cavity, etc. Dental excavators can be used to remove food debris, replace fillings, and scrape out granulations.

5.3. SPECIALIZED KITS

TOOLS

General surgical kit used in primary surgical treatment of wounds of the head and face, treatment of purulent diseases, etc. This set is also a component of most specialized sets for plastic surgery, vascular surgery, oncology surgery, etc. The set consists of scalpels, hemostatic clamps, tweezers, probes, hooks (or retractors), scissors, needles and needle holders, forceps.

Rice. 5.13.Tracheostomy kit:

1 - three-ostomy Luer cannula; 2 - Trousseau tracheostomy retractor; 3 - sharp single-tooth hook for holding the trachea; 4 - saddle hook

Rice. 5.14.Basic set for dental examination: 1 - dental mirror; 2 - dental probe (angular); 3 - dental tweezers; 4 - dental spatula; 5 - dental excavator

Tracheostomy kit (Fig. 5.13) consists of a Trousseau tracheostomy retractor, a tracheostomy cannula, a sharp hook for holding the trachea and a saddle hook for the isthmus of the thyroid gland. The use of this set is impossible without general surgical instruments.

The basic dental examination kit (Fig. 5.14) includes:

- dental mirror- consists of a handle and the mirror itself - a curved mirror plate with a focal length of 75 mm. There are non-separable and collapsible modifications, and collapsible mirrors are more convenient - the handle of some of them is made of plastic and fits better in the palm. Intended

mirrors for examining hard-to-reach areas of the oral cavity and posterior internal surfaces of teeth;

- dental probe- available various options executions - curved, sickle-shaped, bayonet-shaped. The probe is designed to detect and inspect carious cavities;

- dental tweezers- intended for inserting turundas and tampons into a wound or carious cavity;

- dental spatula- can be bilateral or unilateral. Used for mixing the filling mass and grinding it. Collapsible spatulas with replaceable tips are very convenient. Some manufacturers complete such kits with disposable tips and reusable handles that fit more comfortably in the palm of your hand;

- dental excavators- spoons vary in diameter (from 0.7 to 2.4 mm, numbers from 1 to 4, respectively), designed for extracting fragments of hard dental tissues, food debris from a carious cavity, removing temporary fillings and dental plaque, scraping granulations;

- smoothers, pluggers-smoothers- differ in the size of the working parts, designed to smooth out the filling mass when closing a carious cavity.

In addition, the basic set includes a kidney-shaped tray into which instruments and dressings are placed. However, a number of manufacturers complete basic sets with their own modified trays or cassettes for holding tools. Such cassettes greatly facilitate the work of the dentist.

Set of tools for filling (Fig. 5.15):

- sleeves for drill- serve to transmit torque from a stationary drill motor to the working part. If a pneumatic rather than a mechanical propulsion device is used, flexible twisted air ducts are used instead of hoses;

- handpieces for sleeve drills- produced straight and angular, used to secure rotating tools (burs, cutters, etc.);

- dental burs- serve for machining hard tissues (tooth, frozen filling mass), differ in shape and purpose: burs - for primary processing, finishers - for final processing, polishers - for polishing (Fig. 5.16);

- matrix for contour fillings used to temporarily strengthen a filling if one of the walls of the tooth is missing.

A set of tools for working with a root canal (Fig. 5.17):

- root drills(manual and machine) - designed for expanding and leveling root canals, differ in diameter (from 0.25 to 0.45 mm, numbers respectively from 1 to 5);

- drillbors manual and machine - used for probing, expanding and filling the root canal;

Rice. 5.15.Tools for filling:

1 - sleeve for a drill; 2 - straight and angled handpieces for the drill; 3 - matrix for contour fillings

Rice. 5.16.Dental burs (from: Bezak V.I., 1969). For treating deep carious cavities: 1 - fissure cylindrical with double cutting; 2 - fissure cylindrical with single thread; 3 - fissure conical with double cutting; 4 - fissure conical with double cutting. For processing, spiky-shaped; 6 - wheel-shaped back conical. For treating shallow carious cavities: 7 - ball (spherical) bur. To prepare the filling for polishing: 8 - spherical finish. For polishing a filling: 9 - ball-shaped polisher

Rice. 5.17.Tools for working with the root canal: 1 - manual root drill; 2 - machine root drill; 3 - manual drill; 4 - machine drilling; 5 - root needle; 6 - channel filler; 7 - pulp extractor

- root needlesMiller - differ in diameter (0.17, 0.19, 0.21 mm, numbers 1, 2, 3, respectively), intended for the introduction of medicinal substances into the root canal and its subsequent filling;

- channel fillers - designed for filling the root canal with a filling mass;

- pulp extractors- can be made with a long or short handle. Used to remove remaining pulp from the root canal.

5.4. POSITION OF INSTRUMENTS ON THE INSTRUMENTAL TABLE OF THE OPERATING NURSE

When performing general surgical operations You should adhere to certain rules for the location of tools and soft equipment.

The operating nurse covers the mobile small instrument table with a sheet folded in half so that one half of the sheet covers the table, and the other hangs down and then

Rice. 5.18.Methods of stacking instruments on a small instrument table: A - left-handed; B - right-handed

could close the collected tools. The operating nurse uses a forceps to transfer the necessary instruments from a large instrument table to a small one and arranges them in a certain order. Depending on the position of the table - to the right of the operating table (next to the surgeon) or to the left of the table (next to the first assistant) - the instruments are placed in two ways.

The layout of the surgical team and the instrument table for various operations is shown in Fig. 5.18.

When the nurse's table is positioned to the right of the patient, the arrangement of instruments and material is shown in Fig. 5.18, B. On the right edge of the table (from the operating nurse’s side) there are napkins in three packs: large napkins at the back, then medium and small ones. Along the front edge (closer to the surgeon) are placed the instruments that are constantly needed during surgery: hemostatic clamps, Mikulicz clamps, tweezers, scissors, hooks. The surgeon and his assistants take the instruments from the front edge of the table, and the nurse only maintains order on the table and restores the correct placement of the instruments.

The rear edge of the table is at the full disposal of the operating nurse, and the surgeon does not touch it. Spare tools are located here, ready for use; The suture material and the operating nurse's scissors are also located here.

The operating nurse has no right to touch instruments that have been used in surgery and are stained with blood. As a last resort, she removes them with a forceps. When the nurse's table is positioned to the left of the patient, the arrangement of instruments and material is shown in Fig. 5.18, A.

5.5. SURGICAL STAPLE EQUIPMENT

The idea of ​​using metal staples when performing gastric resection was first expressed in 1903 by the Hungarian surgeon Hültl. The first device for such manipulations was proposed in 1921 by surgeon Petz. However, due to significant shortcomings, it was not widely used. A real breakthrough was made in 1949, when in the USSR a device for applying a circular vascular suture was developed and introduced into clinical practice. In the 50-70s of the twentieth century in our country, they were developed in different years production of more than 40 types of various stapling devices for connecting or suturing various organs was carried out

and fabrics (Fig. 5.19). Apparatuses for applying a circular vascular suture (ASTS-4, ASC-8, ASC-20), a universal device for suturing blood vessels (US-18), a device for linear vascular suture (ALSh-20), and a device for suturing have become quite widely used. heart auricle (UUS-20), devices for suturing the bronchial stump (UKB-25, UKB-16) and lung root (UKL-40 and UKL-60), lung tissue(UTL-105), for suturing bronchi (SB-2 and SB-3), device for applying esophageal-gastric anastomosis (PKS), device for applying gastrointestinal anastomosis (NZHKA-60), devices

Rice. 5.19.Stitching machines: 1 - ASC; 2 - UKL; 3 - UO

for suturing the sternum, ribs, clavicle and lower jaw (SGR-20, SRKCH-22). Multi-purpose devices are the device for suturing soft tissues (SMT-2), devices for suturing organs (UO-40, UO-60). IN last years Disposable staplers have become widespread.

The design principle of all these devices is the same. Each such device consists of: a device for fixing sutured organs and tissues; store with brackets; devices for pushing out staples; matrices for bending brackets.

The essence of the operation of the stitching machine is as follows. After fixing the tissues to be stitched, the mechanism for pushing out the U-shaped staples is activated, which, having passed through the edges of the tissues, rest against the matrix and take on a V-shape. Depending on the need, a mechanical suture can be single or double-row, linear or circular, with longitudinal or transverse arrangement of staples, applied simultaneously with all staples or sequentially.

Stapling devices allow you to perform three typical surgical techniques: joining tissues or parts of organs, forming anastomoses of hollow organs, and forming organ stumps.

Stapling devices significantly reduce the dependence of the quality of sutures on the individual professional characteristics of surgeons, simplify the surgical technique, speed up the operation, and increase the reliability of the sutures.

However, there are contraindications to the use of staplers, primarily the presence pathological changes in stitched tissues (inflammatory or sclerotic processes).

5.6. DENTAL EQUIPMENT

Dental equipment is a set of devices necessary for the functioning of a dental office. The main devices are a dental chair, a drill, a dental light, and a compressor. Equipment also includes diagnostic and display systems.

A dental chair is necessary to accommodate the patient. In some cases, it can be replaced by a regular chair (for example, during on-site preventive examinations).

A drill is necessary to create torque for working with burs, drills, and sections. In this case, the torque itself is transmitted using a flexible hose, or drive. At the end of the drive there is a handpiece for the drill. It can be straight or angular depending on the damage to the tooth, its location, etc. The tip is used to secure the instrument itself (see burs, drills).

A dental light is needed to illuminate the oral cavity. It consists of a support (stand), lamp and reflector. There are shadowless modifications of illuminators that have several lamps located around a circle. The main requirement for illuminators is a clear limitation of the light field, since otherwise the light may shine into the patient’s eyes.

The compressor is used to dry the mouth, suction saliva, etc. It can be used to create torque (using special air hoses and air tips), and then it can act as a drill.

Diagnostic systems are designed, on the one hand, to determine the volume and type of treatment, and on the other, to objectively assess the results of treatment by both the doctor and the patient (imaging systems). These systems include devices for x-ray diagnostics, negatoscopes, and dental video systems.

Devices for X-ray diagnostics are X-ray machines (classical or film), computer tomographs, NMR tomographs. Currently, the use of radiovisographs is becoming increasingly relevant, in which X-ray radiation is recorded not by film, but by a digital sensor connected to a computer, which performs the final processing and presentation of the image. There are panoramic and sighting radiovisographs. The use of computer technology in the work of a dentist can greatly facilitate the archiving of patient data by creating databases. As a result, previous images can be requested at any time for comparison with subsequent ones.

X-ray films are designed to facilitate the evaluation of radiographs. In some cases, they are integrated into the medical unit of the dental unit.

Dental video systems are an intraoral camera connected to a computer. The main requirements

requirements for such cameras are miniaturization and hygiene.

Currently, dental equipment is fully or partially integrated into dental units.

A dental unit is a complex of electrical, mechanical and hydraulic elements that converts external energy into the energy of dental instruments and is designed to provide the necessary conditions for dental treatment. Note that, in accordance with the definition, the complex of the above

devices, even if not connected to each other, can be considered a dental unit. However, here and further we will describe industrially manufactured dental units, made in the form of a single complex, all elements of which are interconnected (Fig. 5.20).

Classification of dental units

By mobility: portable stand-alone, portable connected, mobile, stationary.

According to completeness: complete, incomplete (one or more elements are missing).

By the number of tools: for 1, 2, 3, 4 tools and modular with the ability to connect tools one at a time.

By type of illumination on the sleeves: without illumination, with one light guide, with illumination on several sleeves.

By type of micromotor: air, electric without backlight, electric with backlight.

According to the system for evacuating fluid from the oral cavity: with a saliva ejector, with a saliva ejector and an injection vacuum cleaner, with a saliva ejector and a vacuum vacuum cleaner.

Rice. 5.20.External view of the dental unit (Smile unit)

The basic package of the dental unit includes:

Patient chair - can be hydraulically or electrically driven, in modern installations allows, if necessary, to place the patient lying down or in the emergency position - the Trendelenburg position (with the head end down). The upholstery of the chair should be wear-resistant and easy to clean.