Laparotomy Instruments

• Basic laparotomy instruments are essential for general surgery.
• Instruments are categorized into retracting/occluding, cutting/dissecting, clamping/occluding, and grasping/holding types.

Retracting and Exposing Instruments

• Used to hold back organs or tissues to expose the operative site
• Self-retaining retractors stay open on their own
• Manual retractors are held by hand
• The blade is the key part to identify retractors

Manual Retractors

• Deaver retractors are for deep abdominal or chest incisions and come in various widths.
• Richardson retractors are for deep abdominal or chest incisions.
• Army-Navy retractors, also known as USA or US Army, are for shallow or superficial incisions.
• Goulet retractors are for shallow or superficial incisions.
• Malleable or Ribbon retractors are for deep wounds and can be bent to different shapes.

Self-Retaining Retractors

• Weitlaner retractors retract shallow incisions.
• Gelpi retractors retract shallow incisions.
• Balfour retractors with bladder blade retract wound edges during deep abdominal procedures.

Cutting and Dissecting Instruments

• These instruments are sharp and are used to cut body tissue or surgical supplies.
• Blades are used with blade/scalpel holders
• Bandage scissors remove bandages and dressings, with a blunt probe for safety under bandages.
• Straight Mayo scissors are also know as suture scissors and are used to cut suture and supplies.
• Curved Mayo scissors cut heavy tissues like fascia, muscle, uterus, and breast, and come in regular and long sizes.
• Metzenbaum scissors are for cutting delicate tissue. Available in regular and long size.

Clamping and Occluding Instruments

• These instruments compress blood vessels or hollow organs to achieve hemostasis or prevent contents spillage.
• Hemostats clamp blood vessels or tag sutures, with straight or curved jaws; also known as crile, snap, or stat
• Mosquito forceps clamp small blood vessels and have straight or curved jaws.
• Kelly forceps clamp larger blood vessels and tissues; available in short and long sizes; also called Rochester Pean.
• Burlisher forceps clamp deep blood vessels, feature two closed finger rings, and are called tonsil hemostats when they have an open finger ring; alternate names include Schindt tonsil forcep and Adson forcep.
• Right Angle forceps clamp hard-to-reach vessels and place sutures; a right angle with suture is a "tie on a passer," also called Mixter.
• Hemoclip Appliers apply metal clips onto blood vessels and ducts to occlude them.

Grasping and Holding Instruments

• These instruments hold tissues, drapes, or sponges.
• Allis forceps grasp tissue and come in short and long sizes; Judd-Allis holds intestinal tissue, Heavy Allis holds breast tissue.
• Babcock forceps grasp delicate tissue (intestine, fallopian tube, ovary) and are available in short and long sizes.
• Kocher forceps grasp heavy tissue and can be used as a clamp, with straight or curved jaws; also called Ochsner.
• Foerster sponge sticks grasp sponges and are also called sponge forceps.
• Dissectors hold peanut sponges.
• Backhaus towel clips hold towels and drapes, also known as towel clips.
• Pick ups, thumb forceps, and tissue forceps come in various lengths, with or without teeth, and with smooth or serrated jaws.
• Russian tissue forceps grasp tissue.
• Adson pick ups grasp delicate tissue and with teeth are used to grasp the skin; also called Dura forceps.
• Dressing forceps are long, smooth pick-ups, with short smooth-ups for delicate tissue.
• DeBakey forceps are used to grasp delicate tissue, particularly in cardiovascular surgery.
• Mayo-Hegar needle holders hold needles when suturing which may also be place in the sewing category.

Surgical Instrument Counting

• Counting all accountable items is a must throughout the operative procedure.
• Initial counts are done before procedure to create a baseline.
• Additional counts are done before closure of cavities within a cavity.
• First count is done before wound closure begins.
• Final count is done at skin closure or at the end of the operative procedure(s).
• Relief count is done at the relief of the scrub person

Purpose of Surgical Counting

• Ensures removal of all items used during a surgical procedure.
• Reduces the risk of injury from a retained foreign body.
• Perioperative RN in charge of the case is responsible.

Items to be Counted

• Sponges must be counted.
• Sharps need to be accounted for.
• Instruments must be counted.
• Miscellaneous items small enough to be retained should be counted.

Sponges Definition

• Laparotomy sponges must be counted.
• Raytecs (4x4 and 4x8) must be counted.
• Cottonoids and neuro-patties must be counted.
• Dissectors such as kittners or peanuts must be counted.
• Deaver covers and clamp covers should be counted.
• Umbilical tape needs to be counted.
• Tonsil and cylindrical sponges should be counted.

Sharps Definition

• Suture needles should be counted.
• Scalpel blades need to be accounted for.
• Hypodermic needles need to be counted.
• Electrosurgical needles and blades should be counted.
• Safety pins and dura hooks should be counted.
• Razor blades and weck blades are counted

Instrument Counts

• All instruments used in the procedure are to be included in counts including all pieces.

Adding Instruments During the Case

• When a new set of instruments is introduced, it is counted in its entirety before instruments are removed, even if only one or two items are needed.
• The introduced set is then included as part of all counts during the procedure.

Miscellaneous Counted Items

• Vessel loops are counted.
• Suture boots are counted.
• Cautery scraper pads (scratch pads) are counted.
• Irrigating tips are counted.
• Any item small enough to be retained is counted.
• The circulating nurse and the scrub nurse count together and out loud, while visualizing each item.
• Counts not completed prior to skin incision will be considered incorrect.
• An inventory count will be completed at the end of the case, when no initial count had been recorded.
• Additional counts are required when multiple teams are working in the same site, sponge counts will be completed at the conclusion of each procedure.
• Additional counts are required with multiple sites, multiple teams (e.g. mastectomy/team flap).
• Additional counts are required with multiple site cases where more than one individual procedure is completed, so counts are completed separately.