Needle holder. Gegar needle holders. Threading the surgical needle. How to hold a Gegar needle holder in your hands? Gegara needle holder: a surgical instrument with special properties See what "Troyan's needle holder" is in other dictionaries
1. Operational technology. Separation of tissues. Tissue separation techniques. Stopping 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 the 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. Plate hooks (Farabefa). Volkmann's serrated hooks (blunt and sharp). How to hold the hooks in your hands?
7. The probe is grooved. Grooved probe. Deschamp ligature needle. How do I hold the grooved probe and Deshan needle in my hands?
8. Kornzang straight. Curved forceps. Hemostatic clamps. How to hold the clamp and hemostat in your hands?
9. Tools for connecting soft tissues. Surgical needles. Surgical needles. Types of needles. Classification of surgical needles.
10.
Needle holder. Gegar needle holders. Threading the surgical needle. How to hold a Gegar needle holder in your hands?
Purpose of the Gegar needle holder: fixing the needle for easy suturing and avoiding finger 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 criss-crossing cuts are applied to increase friction between the needle and jaws and firmly fix the needle (Fig.2.14).
Figure: 2.14. Needle holder Gegara.Threading the surgical needle.
Preparing the tool for work:
1. Grip the needle with the jaws of the needle holder at a distance of 2-3 mm from its tip - by the narrowest part of the jaws (gripping the needle with the wider part of the needle holder, closer to the screw, can lead to needle breakage). In this case, 2/3 of the length of the needle from the point should be free and to the left of the needle holder (for right-handed people), the point of the needle is directed towards the loader.
2. To thread the suture into the needle, grasp the long end of the suture into a fist along with needle holder handles working hand, and the other pulls its short end along the tool, winds it behind the needle to the left of it and, using the needle as a stop, pulls the thread to the right of the needle holder and brings it to the cut in the middle of the eyelet. With a tightly stretched thread, press on the spring of the eyelet: the thread will spread the walls of the eyelet and pass into it automatically. The ends of the thread are straightened and tied together. One end of the ligature should be 3 times longer than the other (Fig. 2.15).
How to hold a Gegar needle holder in your hands?
Position of the Gegar needle holder in the hand:
Needle holder grabbed into a fist along with the long end of the ligature (if the surgeon works with an assistant, the assistant grabs the long end of the ligature), the second finger is placed along the branch of the instrument and fixed on the screw or branch. The I finger is at the top. In the other hand, the surgeon holds tweezers (surgical - for the skin, anatomical - for other tissues), fixing the tissues to be sutured or holding the needle.
Needle holder — surgical instrument, designed to guide a surgical needle through tissue when suturing.
Requirements for needle holders
1. Ensuring the accuracy of the needle at all stages of suturing.
2. Reliability of fixation of the needle in the working part of the tool.
3. Easy to grip and release the needle.
4. Lack of "chopping effect" when fixing the needle.
5. Versatility when it is necessary to combine fabrics with different properties.
6. Stability of position in the surgeon's hand.
7. Compliance with the requirements of ergonomics.
8. Preservation of working surfaces of operational properties for a long time.
9. The ability to connect the edges of the wound not only on the surface, but also in the depth of the wound with the same tool.
10. Balanced design, excluding the emergence of a "lever" effect.
Design features needle holders
The design elements of the needle holder are shown in Fig. 50.
The working ends of the needle holder are usually short, massive, blunt-pointed.
Slicing on them can be performed in the following options:
- longitudinal grooves (one central groove or several parallel grooves);
- transverse notches - shallow or deep;
- cross-shaped notches (fig. 51).
Figure: 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 - rack.
Figure: 51. Variants of notches on the working surfaces of the needle holders (after: Semenov G. M., Petrishin V. L., Kovshova M. V. Surgical seam, 2002):
1 - longitudinal groove; 2 - transverse notches; 3 - cruciform notches.
An abrasive ("diamond") coating can replace notches. It is applied as a monolayer.
The design of the working parts (branches) 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 given position with a lock (ratchet). In some cases, the needle holder does not have a lock - the handles of the needle holder 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, precision action, and stable position of the needle without deformation. To perform the necessary manipulations, both needle holder handles usually end in 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 grip is slightly 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;
- the place near the axis of the crossing handles is fixed with the tip of the second finger.
Thus, the fingers of the hand form a triangle-shaped figure, which ensures a stable position of the instrument in the hand (Fig. 52).
Figure: 52. The correct position of the needle holder in the surgeon's hand (after: Semenov G. M., Petrishin V. L., Kovshova M. V. Surgical suture, 2002).
By locking the handles of the needle holder in the palm of your hand with your clenched fingers, it is necessary to repeatedly change the position of the hand and instrument during the seam. At one point, the uncontrolled position of the needle, fixed in the needle holder, can lead to iatrogeal damage by the tip of one of the elements of the neurovascular bundle.
The design of the handles of the Mathieu and Troyanov needle holder is such that they are fixed by squeezing the fingers of the hand. The tool lock rests on the palm, which is a prerequisite for possible damage to the surgical gloves and the surgeon's palm. These disadvantages complicate the use of these needle holders in modern surgery (Fig. 53).
Figure: 53. Mathieu needle holder (after: Medicon instruments, 1986).
In practice, the most commonly used Gegar needle holders with handles of various lengths. Performing actions in the pelvic cavity using 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 instrument with a small amplitude of handles movements. Long-term special training allows you to correct this deficiency (Fig. 54).
In some cases, there are cutting edges in front of the fixing surfaces of the needle holder, allowing them to be used for crossing the threads (Olier-Gegara needle holder).
Figure: 54. Gegar's needle holder (after: Medicon Instruments, 1986 [/]).
A prerequisite the correct fixation of the needle is its position near the tip of the needle holder (at the border of the distal and middle third 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 the "chopping" effect. In addition, damage to one of the ends of the needle holder is possible, since the force applied by the created lever can exceed the safety margin of the tool design. Fastening the needle in another extreme position - directly at the tip of the needle holder - is accompanied by its unstable position - slipping out (Fig. 55).
When piercing tissues with a needle, the needle holder should be fixed by the hand, making 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 pass through the end part of the wound channel formed by it in exact accordance with the shape of the needle bend, minimizing tissue trauma.
Figure: 55. The position of the needle in the tip of the needle holder (after: Semenov G. M., Petrishin V. L., Kovshova M. V., 2002):
a - correct - near the tip of the needle holder; b - wrong - near the axis with a possible breakage of the needle holder; c - wrong - 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).
Locks of original designs can be used to fix the handles in a certain position (Fig. 57). Design features of microsurgical needle holders
The microsurgical needle holder has the following distinctive features:
1. Smooth surfaces of working parts.
2. Recoil spring devices at the ends.
3. Support platforms on handles (fig. 58).
4. For reliable fixation, the working tips of the needle holder can be bent along the plane. How to work with a microsurgical needle holder:
Figure: 56. Needle holders for suturing tissue in the depth of the wound (after: Medicon Instruments, 1986):
a - curved Cliner needle holder; b - bent Finochetto needle holder.
Figure: 57. Needle holders with a "hook lock" (after: Medicon Instruments, 1986):
a - needle holder with "hook lock" Arruga; b - needle holder with "hook lock" Potts - Smith.
Figure: 58. Jacobson's microsurgical needle holder (after: Medicon Instruments, 1986).
1. The 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 the 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 Is a specialized instrument with which a suture needle is passed through soft tissue.
Specifications
The product can be in the form of tongs or scissors. The last modification is more convenient. Both have a lock (ratchet) to securely fix the jaws 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 racks are good for working with atraumatics. The design of branches (main working parts) can be split or one-piece. In the first case, removable parts are made of softer alloys than the structure itself. If the thumb ring in the model is oversized, then the handle is shortened compared to standard length instruments.
3 types of notches can be applied on the working surfaces: longitudinal, cruciform, transverse groove. 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 in many models from Russian manufacturers, stainless medical steel is superior in quality. The service life corresponds to that stated by the manufacturer.
Benefits
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 the general surgical needle holder must meet:
- reliability of needle fixation;
- lack of the so-called "chopping effect";
- precise positioning of the needle when creating stitches and forming knots;
- convenience for the practitioner (ergonomics, stability when positioned in the hand);
- quick and easy handling (including gripping / releasing the needle);
- versatility when sewing 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.);
- ease of work when making deep seams and surface seams, without changing the needle holders.
In modern medicine, a microsurgical needle holder is most often used when suturing vessels. This tool is irreplaceable in ophthalmology. And for ease of manipulation, such a toolkit has slightly different dimensions, but the balance of the structure must be accurately preserved.
Varieties and scope
The most common types:
- the Gegara needle holder has a classic look. May be with different types notches, length and width of the handles.
- mathieu needle holder with springy handles, automatic shutter. It is used in dentistry and ophthalmology.
- Barracker needles holder for microsurgery (in eye surgery).
- the Codevilla tool is used for stitching the tendons and is designed to use straight needles. The shape of one handle is more complex.
- castroviejo needle holder, common in vascular surgery. It looks like tweezers.
To buy a Gegar or Mathieu needle holder, contact the specialists of the MedMart online store for help - you will find best tools for surgery in one place!
Troyanov needle holder (A.A. Troyanov, 1849-1916, domestic)
a tool for holding surgical needles when suturing, characterized in that the fixing is located on the end part of the handles and is unbuttoned with the V 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 "Troyanov needle holder" is in other dictionaries:
- (A.A. Troyanov, 1849 1916, edematous surgeon) a tool for holding surgical needles when suturing, characterized by the fact that the fixing ratchet is located on the end part of the handles and is unbuttoned with the V finger of the hand ... Big Medical Dictionary
Scalpels Surgical instrument specially manufactured instrument for use during surgical procedures. Contents ... Wikipedia
- (1849-1916), surgeon. Works 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 surgical symptoms are named after Troyanov ... Big Encyclopedic Dictionary
The phrase "needle holder Gegara (Hegara)" has been heard by a few, only those who are quite familiar with medicine, or rather, with surgery. But even the common man is interested in knowing 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, easy to use. The Gegar, or Mathieu, or Troyanova, or Castroviejo needle holder 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. Over the centuries of surgical development, medical practitioners have developed several designs of such a surgical instrument. They differ in some features of its various parts.
Many global companies engaged in the production of medical equipment and instruments also produce surgical instruments, such as, for example,needle holder Mayo-Hegar. 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 from high quality medical grade stainless steel.
What should be the needle holder?
The Gegara needle holder has several varieties that allow you to use given view medical instrument in carrying out various surgical interventions. But whatever it is, its quality must be impeccable. What are the requirements of surgeons for such an instrument?
- absolute precision in the course of the needle at all stages of work;
- simple algorithm for gripping and releasing the needle;
- the needle in the branches (working parts of the needle holder) must be securely fixed;
- comfortable, efficient work on various fabrics;
- ergonomics and stability of the tool;
- safety of the needle during operation, as a result of the absence of the "cutting effect of the jaws";
- long-term operation with the preservation of all working qualities;
- balance of the structure, excluding the occurrence of a "lever" effect and rupture of the connected tissues.
Types of needle holders
The Gegara needle holder is a tool to assist the surgeon in suturing. It allows you to work on various 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, a needle holder Olsen Gegara (Olsen Hegara) has special scissors on the branches for cutting off the working thread.
Also, the surgeon's suture tool can have long or shortened handles, different reliefs on the branches - mesh or oblique notches, a longitudinal groove, an abrasive monolayer. In some forms of needle holders, the branches are made of removable parts from soft alloys. 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 due to the unstable position of the needle in operation or from the breakage of the needle itself as a result of the "chopping effect".
Also, the surgeon's stitching tool can have a special lock - a ratchet that allows you to fix the given position of the handles and jaws. Needle holders without racks are often used for.In its design, the Gegara needle holder is somewhat reminiscent of ordinary office or household scissors, and just like scissors, very often its types are equipped with rings at the ends for a convenient location and secure fixation in the surgeon's hand. Moreover, in some cases, the thumb ring is performed bigger sizethan the neighboring one.
In the work of a surgeon, a huge number of instruments are used - primary or secondary. It must always be of high quality and meet safety requirements. The Gegara needle holder is a classic version of this kind of surgical instrument designed to hold the needle without touching the hands during suturing.
