Needle holder. Gegar needle holders. Putting thread on a surgical needle. How to hold a hegara needle holder in your hands? Hegar's needle holder: a surgical instrument with special properties See what the "Troyan needle holder" is in other dictionaries
1. Operational technique. Separation of tissues. tissue separation methods. Stop bleeding. Temporary stop of bleeding. The final stop of bleeding.
2. Surgical instruments. Classification of surgical instruments. General purpose instruments in surgery.
3. Instruments for separation of soft tissues in surgery. Scalpel. Surgical knives.
4. Surgical scissors. Surgical scissors. Types of scissors. How to hold surgical scissors in your hands?
5. Auxiliary tools. Tweezers. Types of tweezers. How to hold tweezers in your hands?
6. Lamellar hooks (Farabefa). Hooks serrated (blunt and sharp) Volkmann. How to hold hooks in your hands?
7. The probe is grooved. Grooved probe. Deschamps ligature needle. How to hold a grooved probe and a deschan needle in your hands?
8. Straight forceps. Korntsang curved. Hemostatic clamps. How to hold the forceps and hemostatic forceps in your hands?
9. Instruments for connecting soft tissues. Surgical needles. Surgical needles. Types of needles. Classification of surgical needles.
10.
Needle holder. Gegar needle holders. Putting thread on a surgical needle. How to hold a hegara needle holder in your hands?
Appointment of the Hegar needle holder: fixation of the needle for the convenience of suturing and preventing fingers from touching the tissues.
Gegar needle holder device: similar in design to hemostatic clamps, but have more massive and shorter jaws, on the surface of which small intersecting cuts are applied to increase friction between the needle and jaws and firmly fix the needle (Fig. 2.14).
Rice. 2.14. Needle holder Gegara.Putting thread on a surgical needle.
Preparing the tool for work:
1. Grab the needle with the jaws of the needle holder at a distance of 2-3 mm from its tip - with the narrowest part of the jaws (grabbing the needle with the wider part of the needle holder, closer to the screw, can lead to breakage of the needle). In this case, 2/3 of the length of the needle from the tip should be free and be to the left of the needle holder (for right-handed people), the tip of the needle is directed towards the loader.
2. To thread the suture into the needle, the long end of the thread is grasped into a fist along with needle holder handles working hand, and the other pulls its short end along the tool, leads it behind the needle to the left of it and, using the needle as an emphasis, pulls the thread to the right of the needle holder and brings it to the incision in the middle of the eye. With a tightly stretched thread, they press on the spring of the ear: the thread will separate the walls of the ear and pass into it automatically. The ends of the thread are straightened and connected together. One end of the ligature should be 3 times longer than the other (Fig. 2.15).
How to hold a hegara needle holder in your hands?
The position of the Hegar needle holder in the hand:
Needle holder they are captured in a fist along with the long end of the ligature (if the surgeon works with an assistant, the assistant captures the long end of the ligature), the second finger is placed along the jaw of the instrument and fixed on the screw or jaw. The first finger is at the top. In the other hand, the surgeon holds tweezers (surgical - for the skin, anatomical - for other tissues), fixing the tissue to be stitched or holding the needle.
Needle holder — surgical instrument designed to pass a surgical needle through tissue during suturing.
Needle holder requirements
1. Ensuring the accuracy of the needle at all stages of suturing.
2. Reliability of fixing the needle in the working part of the tool.
3.Easy to grip and release the needle.
4. The absence of a "chopping effect" when fixing the needle.
5. Versatility when it is necessary to connect fabrics with different properties.
6. Stability of the position in the hand of the surgeon.
7. Compliance with the requirements of ergonomics.
8. Preservation of operational properties by working surfaces for a long time.
9. The possibility of connecting the edges of the wound not only on the surface, but also in the depths of the wound with the same tool.
10. Balanced design, eliminating the occurrence of a "lever" effect.
Design features needle holders
The structural elements of the needle holder are shown in fig. 50.
The working ends of the needle holder are usually short, massive, blunt.
Cutting on them can be performed in the following options:
- longitudinal furrows (one central furrow or several parallel grooves);
- transverse notches - small or deep;
- cruciform notches (Fig. 51).
Rice. 50. Elements that make up the design of the needle holder (according to: Medicon instruments, 1986):
1 - working ends with fixing thread; 2 - lock; 3 - handles; 4 - rings for fixing the needle holder in the hand; 5 - kremalera.
Rice. 51. Variants of notches on the working surfaces of needle holders (according to: Semenov G. M., Petrishin V. L., Kovshova M. V. Surgical suture, 2002):
1 - longitudinal furrow; 2 - transverse notches; 3 - cruciform notches.
Abrasive ("diamond") coating can replace notches. It is applied as a monolayer.
The design of the working parts (jaws) of the needle holders can be integral. However, in some cases, their working surfaces are made in the form of removable (replaceable) parts made of soft alloys. The handles of the needle holders can be fixed in a predetermined position with a lock (kremalier). In some cases, the needle holder does not have a lock - the needle holder handles are held with closed fingers. Such needle holders without a lock are usually used when working with atraumatic needles. This ensures the ease of applied efforts, the precision of actions, the stable position of the needle without its deformation. To perform the necessary manipulations, both handles of the needle holder usually end with rings.
In most designs of needle holders, the rings are oval and have the same parameters. However, in some models, the thumb ring is larger and the corresponding handle is somewhat shorter.
Rules for using needle holders
The correct position of the standard needle holder in the surgeon's hand should be as follows:
- the distal phalanges of the I and IV fingers are inserted into the rings of the needle holder, respectively;
- a place near the axis of the crossed handles is fixed with the tip of the second finger.
Thus, the fingers of the hand form a figure in the form of a triangle, which ensures a stable position of the instrument in the hand (Fig. 52).
Rice. 52. The correct position of the needle holder in the hand of the surgeon (according to: Semenov G. M., Petrishin V. L., Kovshova M. V. Surgical suture, 2002).
Fixing the needle holder handles in the palm of your hand with clenched fingers leads to the fact that you have to change the position of the hand and the tool several times during the seam. At one point, the uncontrolled position of the needle fixed in the needle holder can lead to iatroheipal damage to one of the elements of the neurovascular bundle by its tip.
The design of the handles of the Mathieu and Troyanov needle holders is such that they are fixed by squeezing the fingers of the hand. The lock of the tool rests against the palm, which is a prerequisite for possible damage to surgical gloves and the surgeon's palm. These shortcomings make it difficult to use these needle holders in modern surgery (Fig. 53).
Rice. 53. Mathieu needle holder (according to: Medicon instruments, 1986).
In practice, Gegar needle holders with handles of various lengths are most often used. Performing actions in the pelvic cavity with the help of the so-called "gynecological" Gegar needle holders of considerable length requires special training. Such a need is associated with the formation of a lever structure and a pronounced deviation of the jaws of the tool with a small amplitude of movement of the handles. Long-term special training can correct this deficiency (Fig. 54).
In some cases, there are cutting edges in front of the fixing surfaces of the needle holder, which allow them to be used for crossing threads (Ollier-Gegar needle holder).
Rice. 54. Hegar's needle holder (by: Medicon Instruments, 1986 [/]) .
A prerequisite correct fixation of the needle is its position near the tip of the needle holder (on the border of the distal and middle thirds of the working ends).
Placing the needle between the working surfaces near the crosshairs of the ends of the needle holder will inevitably lead to its destruction due to the development of a "chopping" effect. In addition, damage to one of the ends of the needle holder is possible, since the force applied by the created lever may exceed the margin of safety of the tool design. Fixing the needle in another extreme position - directly at the tip of the needle holder - is accompanied by its unstable position - slipping (Fig. 55).
When piercing tissues with a needle, the needle holder must be fixed with a hand that makes a sequential transition from pronation to supination. When removing the needle from the tissues, the needle holder is grasped by hand in the pronation position. This allows the eye of the needle to be passed through the end part of the wound channel formed by it in exact accordance with the shape of the needle bend, minimally injuring the tissues.
Rice. 55. The position of the needle at the tip of the needle holder (according to: Semenov G. M., Petrishin V. L., Kovshova M. V., 2002):
a - correct - near the tip of the needle holder; b - incorrect - near the axis with a possible breakage of the needle holder; c - incorrect - with the possibility of developing a "chopping" effect; d - unstable position of the needle, fixed in close proximity to the tip of the needle holder (the needle holder is charged for the left hand).
For the convenience of working in the depth of the wound, the working ends of the needle holder can be bent at an angle, and the handles are sometimes given a bayonet shape (Fig. 56).
To fix the handles in a certain position, locks of original designs can be used (Fig. 57). Design features of microsurgical needle holders
The microsurgical needle holder has the following distinctive features:
1. Smooth surfaces of working parts.
2. Return spring devices at the ends.
3. Support platforms on the handles (Fig. 58).
4. For reliable fixation, the working tips of the needle holder can be bent along the plane. Rules for the operation of a microsurgical needle holder:
Rice. 56. Needle holders for suturing tissues in the depth of the wound (according to: Medicon Instruments, 1986):
a - curved needle holder Cleaner; b — curved Finochetto needle holder.
Rice. 57. Hook-Lock Needle Holders (according to: Medicon Instruments, 1986):
a - needle holder with Arrug's "hook lock"; b - needle holder with Potts-Smith "hook lock".
Rice. 58. Jacobson microsurgical needle holder (according to: Medicon Instruments, 1986).
1. A microsurgical needle holder without a lock is held in the "bow" or "pen" position. This greatly improves the accuracy of the needle.
2. When performing particularly precise movements with a microsurgical needle holder, the surgeon's forearms should rest on the armrests.
3. In the process of work, you must constantly monitor the cleanliness of the working surfaces and, if necessary, wipe them.
G. M. Semenov
Modern surgical instruments
General surgical needle holder- This is a specialized instrument with which a needle with suture material is passed through soft tissues.
Specifications
The product may be in the form of tongs or scissors. The last modification is more convenient. Both those and others have a lock (cremalier) for reliable fixation of the sponges in the desired position. In the absence of this element, the specialist has to fix the handles on his own - with his hands. At the same time, surgical needle holders without ratchet are good for working with atraumatic. The design of the branches (main working parts) can be detachable or one-piece. In the first case, removable parts are made of softer alloys than the structure itself. If in the model the thumb ring is oversized, then the handle is shortened compared to standard length tools.
On the working surfaces, 3 types of notches can be applied: longitudinal, cruciform, transverse furrow. They can also be replaced by a diamond layer. For greater strength, surgical needle holders are reinforced with hard alloys. Pakistani products are distinguished by the best performance, although stainless medical steel is superior in quality in many models from Russian manufacturers. The service life corresponds to that declared by the manufacturer.
Advantages
Every surgeon knows that it is important to buy a good quality needle holder. This tool is indispensable for almost any surgical intervention that involves suturing. The main requirements that a general surgical needle holder must meet:
- reliability of needle fixation;
- the absence of the so-called "chopping effect";
- precise positioning of the needle when creating stitches and forming knots;
- convenience for the practitioner (ergonomics, stability when placed in the hand);
- quick and easy manipulation (including the capture / release of the needle);
- versatility when stitching different fabrics;
- high performance properties throughout the entire period of use;
- resistance of working surfaces to mechanical damage and biofluids;
- high quality workmanship (smoothness, no burrs, etc.);
- convenience of work when performing deep seams and superficial, without changing needle holders.
In modern medicine, a microsurgical needle holder is most often used when suturing vessels. Such an instrument is indispensable in ophthalmology. And for the convenience of manipulation, such tools have slightly different dimensions, but the balance of the design must be accurately maintained.
Varieties and scope
The most common types:
- Gegar's needle holder has a classic look. May be with different types notches, length and width of handles.
- Mathieu needle holder with springy handles, automatic shutter. Used in dentistry and ophthalmology.
- Barraquer needle holder for the needs of microsurgery (in eye surgery).
- Codwill's tool is used for suturing tendons, designed for the use of straight needles. The shape of one handle is more complex.
- Castroviejo needle holder, common in vascular surgery. Outwardly similar to tweezers.
To buy a Hegar or Mathieu needle holder, contact the specialists of the MedMart online store for help - you will find best tools for surgery in one place!
Troyan needle holder (A.A. Troyanov, 1849-1916, domestic)
a tool for holding surgical needles during suturing, characterized in that the fixing one is located on the end part of the handles and its unfastening is carried out by the fifth finger of the hand.
1. Small medical encyclopedia. - M.: Medical Encyclopedia. 1991-96 2. First aid. - M.: Great Russian Encyclopedia. 1994 3. encyclopedic Dictionary medical terms. - M.: Soviet Encyclopedia. - 1982-1984.
See what "Troyan's needle holder" is in other dictionaries:
- (A. A. Troyanov, 1849 1916, father-in-law surgeon) a tool for holding surgical needles during suturing, characterized by the fact that the fixing cremalier is located on the end part of the handles and it is unfastened by the fifth finger of the hand ... Big Medical Dictionary
Scalpels A surgical instrument is a specially made instrument for use during surgical interventions. Contents ... Wikipedia
- (18491916), surgeon. Proceedings on skin burns, surgical treatment of varicose veins, etc. He was the first in Russia to remove gallbladder with its acute perforation (1896). A number of symptoms of surgical ... Big Encyclopedic Dictionary
The phrase "needle holder of Hegar (Hegar)" was heard by a few, only those who are quite familiar with medicine, or rather, with surgery. But it is also interesting for a simple layman to find out what these words mean.
Family - surgical instruments
The very name of the object indicates that it is intended for holding a needle, but e If you look at the Gegar needle holder in the photo, it becomes clear that this item belongs to medical surgical instruments.
For what and from what?
Surgery is a special branch of medicine. All items and instruments that are used in the work of surgeons must be functional, sterile, and easy to use. The needle holder of Gegar, or Mathieu, or Troyanov, or Castroviejo is designed to hold the needle when applying the necessary surgical sutures, which means that the requirements for this instrument must be observed very strictly. Practitioners over the centuries of development of surgery have developed several designs of such a surgical instrument. They differ in some features of its various parts.
Many global companies involved in the production of medical equipment and instruments also produce surgical instruments, such as, for example,Mayo-Hegar needle holder. For absolute sterilization, it is most convenient to use materials that do not lose their qualities during autoclaving, irradiation or treatment with disinfectants. Therefore, surgical instruments are mainly made of high-quality stainless steel for medical purposes.
What should be the needle holder?
The Gegar needle holder has several varieties that allow you to use this species medical instrument in carrying out various surgical interventions. But whatever it is, its quality must be impeccable. What are the requirements for surgeons to such an instrument?
- absolute accuracy in the course of the needle at all stages of work;
- a simple algorithm for capturing and releasing the needle;
- the needle in the branches (working parts of the needle holder) must be securely fixed;
- convenient, effective work on various fabrics;
- ergonomics and stability of the tool;
- the safety of the needle during operation, as a result of the absence of the "chopping effect of branches";
- long-term operation with the preservation of all working qualities;
- balanced design, excluding the occurrence of a "lever" effect and rupture of the connected tissues.
Varieties of needle holders
Gegar's needle holder is an assistant tool for the surgeon in suturing. It allows you to work on different tissues and organs, both on the surface of the body and in internal areas, for example, in gynecology. Therefore, it is not surprising that such a surgical instrument is available in several versions. For example, needle holder Olsen Gegara(Olsen Hegara) has special scissors on the branches designed to cut off the working thread.
Also, the surgeon's tool for suturing can have long or short handles, different reliefs on the branches - mesh or inclined notches, a longitudinal groove, an abrasive monolayer. In some forms of needle holders, the jaws are made of removable soft alloy parts. The needle in the working parts of the needle holder must be correctly fixed - in the middle of the jaws, in order to exclude tissue damage when the needle is unstable in operation or from breakage of the needle itself as a result of the "chopping effect".
Also, the surgeon's stitched instrument may have a special lock - cremalier, which allows fixing the specified position of the handles and jaws. Needle holders without cremalers are often used for. By its design, the Gegar needle holder is somewhat reminiscent of ordinary stationery or household scissors, and just like scissors, very often its types are equipped with rings at the ends for convenient location and secure fixation in the surgeon's hand. Moreover, in some cases, the thumb ring is performed bigger size than the neighboring one.
In the work of the surgeon, a huge number of instruments are used - the main or auxiliary. It must always be of high quality and meet safety requirements. The Hegar needle holder is a classic version of this kind of surgical instrument, designed to hold the needle without contact with the hands during suturing.
