Stephen J. Birchard DVM, MS, Diplomate ACVS

Sunday, January 20, 2019

4 Common Mistakes Made When Using Surgical Instruments

One of the most fundamental of surgical skills is proper handling of instruments. Using surgical instruments improperly can make the surgical procedure more difficult and time consuming. Here are 4 mistakes commonly made by inexperienced surgeons, and how to fix them:

1. Needle holders: the instrument is held with the thumb and 4th finger, but there is a right and wrong way to do it (it's all in the thumb!) This also applies to any forceps or scissors with ringed handles. (Fig. 1)
Fig 1a: Incorrect method to hold needle holders or any forceps or scissors
with ringed handles. Note how the thumb is too far inside the ring.
Fig 1b: Correct method to hold needle holders. Note that the only the tip
of the thumb is inserted through the ring of the instrument.

2. Thumb forceps: how the forceps are held can make a world of difference. (Figure 2)
Fig 2a: Incorrect method for holding thumb tissue forceps. This is a
clumsy grip that results in greater tissue trauma. 
Fig 2b: Correct and more precise method for holding tissue forceps. 

3. Retractors: holding them properly will avoid having the assistant's hand obscure the surgical field. (Fig. 3)
Fig. 3a: These are Senn retractors, commonly used in veterinary surgery.
Fig. 3b: Incorrect grip on the retractor. The fingers are too close  to
the end of the retractor resulting in the fingers and hand interfering with
the surgical exposure.
Fig. 3c: Correct grip on the retractor which will keep the fingers away from the
surgical field.

4. Cutting suture ends after tying a knot: here's a hint, use the tips! (Fig. 4)
Fig. 4a: Incorrect method of cutting suture ends with  scissors.
The blades close to the hinge are being used to cut the suture which
obscures the knot, making it difficult to see how long the suture ends will be. 
Figure 4b: Correct method; using the scissor's tips allow the assistant
to see the distance between the knot and the length being cut.
I hope you find these suggestions helpful. Post any questions or comments you may have on instrument handling and technique.