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INTRODUCTION

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It is imperative that surgeons understand the choice and limitations of their instruments and sutures with regard to a planned surgery. This knowledge will often make the difference between struggling or proceeding with purpose. Keeping current on the rapid and ongoing development of instrument technology can be difficult for the busy clinician. Yet taking advantage of these innovations can contribute significantly toward efficiently completing a challenging case. Surgical proficiency requires a well-planned approach with an appreciation and knowledge of the instruments and sutures to be used.

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SURGICAL INSTRUMENTATION

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Every surgeon has a preference for selecting particular instruments as a result of training and experience. Later, these choices are often modified by acquired habits and limits imposed by cost. Surgical instruments are an extension of a surgeon's hands and are designed to facilitate the operative procedure. The list of instruments provided in this chapter is neither comprehensive nor complete. What follows is a functional description of the basic tools for the gynecologic surgeon.

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Scalpels

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The Bard-Parker handle is usually fitted with a disposable blade that is attached using a needle holder. Commonly, the #10 or #20 blade is used for the skin incision and can then be used to extend the incision through the fascia. The #15 blade has a small area useful for confined spaces or small skin incisions. The #11 blade has a straight edge useful for its pointed design in placing drains or opening abscesses. There are also long and curved handles to facilitate dissection in the deep pelvis.

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Scissors

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Scissors, with their long handles and strong blades, serve multiple functions in the operative field from cutting sutures, excising scar tissue, and transecting pedicles to fine dissection of adhesions involving intra-abdominal viscera. Surgical scissors usually come in various sizes and lengths, with straight and curved blades having chamfered or rounded ends. Examples of these are the Mayo and Metzenbaum scissors. The Jorgenson scissors are heavy scissors with sharply curved blades that facilitate the amputation of the cervix off the vaginal cuff.

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Forceps

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Thumb forceps, as the term suggests, act as an extension of the surgeons thumb and index finger for grasping tissue, steadying needles, or exploration. Spring tension keeps the tips apart until pressure is applied to close them. Forceps have a variety of widths and lengths, making them versatile and universally applicable in the operative field. The blade's design and surface configuration will determine its intended use. Adson forceps are used for manipulating the skin, whereas Bonney or Martin forceps have teeth for handling fascia. DeBakey or smooth forceps with a cross-serrated grasping surface make them ideal for handling peritoneum or vascular pedicles. Singley forceps with their fenestration are ideal in atraumatic handling of tissue bundles during lymphatic dissection. Hemostatic forceps (clamps) are light instruments with spring handles, ratcheting closing mechanisms, ...

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