Instrumentarul

chirurgical
 Generalitati
• Totalitatea instrumentelor si
dispozitivelor ce servesc la bunul
mers al unei interventii chirurgicale
• Permit accesul in zone profunde,
inaccesibile mainii chirurgului
• Au contribuit la scaderea
traumatismului tisular si la
miniinvazivitate: jackoscopie,
laparoscopie

12/10/2018 copyright (your organization) 2003 2

 Clasificare
• Instrumente taietoare
• Instrumente de apucat si fixat
• Instrumente de sutura
• Departatoare
• Instrumente pentru chirurgia
osoasa
• Instrumentar laparoscopic

12/10/2018 copyright (your organization) 2003 3

 Instrumentele taietoare
• Bisturiul “rece”
• Bisturiul electric
• Foarfecele

12/10/2018 copyright (your organization) 2003 4

 Bisturiul
• Simbol al actului chirurgical si al
chirurgului, insa paradoxal, cel mai
putin utilizat
• Priza
• Tipuri
1. Monobloc
2. Lama interschimbabila
3. Dispozabil
• Tipul adaptat nevoilor
12/10/2018 copyright (your organization) 2003 5
12/10/2018 copyright (your organization) 2003 6
 Foarfecele
• Principalul instrument taietor
in chirurgie
• Clasificare
1. De pansament Liston
2. De ata
3. De disectie: dreapta sau curba
• Priza: degete 1 si 4

12/10/2018 copyright (your organization) 2003 7

 Foarfeca Liston de
pansament

12/10/2018 copyright (your organization) 2003 8

 Foarfeci de disectie

12/10/2018 copyright (your organization) 2003 9

 Foarfeca dura, “de ata”

12/10/2018 copyright (your organization) 2003 10

 Foarfeca de microchirurgie

12/10/2018 copyright (your organization) 2003 11

 Bisturiul electric
• Mod de functionare:
taiere/coagulare
• Pe cale clasica sau
laparoscopica

12/10/2018 copyright (your organization) 2003 12

 Pensa anatomica
• Prehensiune fina, in
profunzime, lungimi
diferite, fara dinti
• Mana stanga apuca,
mana dreapta
sectioneaza
• Particular in
microchirurgie

12/10/2018 copyright (your organization) 2003 13

 Pensa chirurgicala
• Dura, cu dinti, lungimi
diferite
• Piele, aponevroza,
musculatura, bont
vaginal

12/10/2018 copyright (your organization) 2003 14

 Pense hemostatice
• Pean
• Kocher
• Mosquito
• Halstedt

12/10/2018 copyright (your organization) 2003 15

 Pensa Pean
• Cea mai folosita in
chirurgie
• Cremaliera
autostatica
• Zimti transversali pe
toata lungimea,
FARA DINTI LA
CAPAT- caracter
atraumatic
• Drept sau curb

12/10/2018 copyright (your organization) 2003 16

 Pensa Mosquito
• Pensa Pean mica-
10cm, fina
• Chirurgia vasculara
si tiroidiana

12/10/2018 copyright (your organization) 2003 17

 Pensa Kocher
• Pensa hemostatica dura, grosiera
• Zimti pe toata lungimea+2 dinti la capat-
traumatica
• Hemostaza pe structuri ferme: uter, muschi

12/10/2018 copyright (your organization) 2003 18

 Pensa Halstedt
• Kocher mic

12/10/2018 copyright (your organization) 2003 19

 Pensa porttampon
• Toaleta plagilor
• Asepsia
campului
operator

12/10/2018 copyright (your organization) 2003 20

 Pensa Museux, “de uter”
• Puternica, lunga,
prevazuta cu dinti la
capat+ cremaliera
• Pensa Chaput-
identica dar mai
mica, la excizia tu.
Mici
• Pensa de plaman-
atraumatica

12/10/2018 copyright (your organization) 2003 21

 Pense pentru fixarea
campurilor
• Carabus-delimiteaza campul
operator
• Bachaus-izolarea tegumentului
• Doyen-izolare tegumentara la
gusa
• Mikulicz-izolare peritoneu-
diferentierea de Kocher

12/10/2018 copyright (your organization) 2003 22

 Bachaus

12/10/2018 copyright (your organization) 2003 23

 Mikulicz

12/10/2018 copyright (your organization) 2003 24

 Pense speciale atraumatice

• En coeur-de limba sau de

colecist
• Klammer intestinala
• Duodenala
• “in L”-de rect

12/10/2018 copyright (your organization) 2003 25

 En coeur

12/10/2018 copyright (your organization) 2003 26

 Klammer –nu pe mezou!

12/10/2018 copyright (your organization) 2003 27

 Alte pense
• Dejardin-de calculi
• De cistic-ca un pean fin

12/10/2018 copyright (your organization) 2003 28

 Instrumente se sutura
• Portac Mathieu
• Portac Hegar
• Ac Reverdin
• Ac Deschamp
• Ac Hagedorn
• Ac Bassini
• Stapler

12/10/2018 copyright (your organization) 2003 29

 Portac Mathieu
• Grosier, sutura
superficiala: piele
musculatura, aponevroza
• Priza

12/10/2018 copyright (your organization) 2003 30

 Portac Hegar
• Suplu, sutura
fina, in
profunzime
• Priza

12/10/2018 copyright (your organization) 2003 31

 Ac Reverdin
• Grosier, 2
treceri prin
tesut
• Chirurgia
laparoscopica
peretelui
abdominal
• Buton si clapeta
ce culiseaza

12/10/2018 copyright (your organization) 2003 32

 Ac Deschamp-urechea la
varf
• Grosier, 2
traversari
• De dreapta si de
stanga
• In combinatie cu
sonda Payr

12/10/2018 copyright (your organization) 2003 33

 Staplere
• Linear/circular
• Dimensiuni variabile
• Clasic/laparoscopic
• Agrafe diferite
• Scurteaza durata, creste
acuratetea
• Scoate factorul eroare umana
din rata de fistule
12/10/2018 copyright (your organization) 2003 34
12/10/2018 copyright (your organization) 2003 35
 Departatoare
• Farabeuff-2 lame
• Kocher-1 lama + maner
• Volkmann –cu dinti
• Valve abdominale
• Autostatice vasculare
• Autostatic Gosset
• Autostatic Finochetto

12/10/2018 copyright (your organization) 2003 36

 Farabeuff

12/10/2018 copyright (your organization) 2003 37

 Kocher

12/10/2018 copyright (your organization) 2003 38

 Volkmann

12/10/2018 copyright (your organization) 2003 39

 Valva abdominala

12/10/2018 copyright (your organization) 2003 40

 Autostatic vascular

12/10/2018 copyright (your organization) 2003 41

 Gosset

12/10/2018 copyright (your organization) 2003 42

 Finochetto

12/10/2018 copyright (your organization) 2003 43

 Chirurgia laparoscopica

12/10/2018 copyright (your organization) 2003 44

12/10/2018 copyright (your organization) 2003 45
 Pense atraumatice pentru
chirurgia vasculara-
clampuri
• Dieffenbach-
buldog, vase
mici
• Satinski-clam
puternic, vase
mari

12/10/2018 copyright (your organization) 2003 46

 Chirurgia osoasa 1 Luer

12/10/2018 copyright (your organization) 2003 47

 Chirurgia osoasa 2

Volkmann

Gigli

12/10/2018 copyright (your organization) 2003 48

 Sonde
• Nelaton
• Pezzer
• Thiemann
• Foley

12/10/2018 copyright (your organization) 2003 49

12/10/2018 copyright (your organization) 2003 50
 Dren Kehr

12/10/2018 copyright (your organization) 2003 51

 Ati inceput chirurgia cu dreptul !!!

12/10/2018 copyright (your organization) 2003 52