Table of contents of the subject "Operative technique. Surgical instruments.":
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. Lamellar 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 you hold the grooved probe and Deshan needle in your hands?
8. Kornzang straight. Curved forceps. Hemostatic clamps. How to hold the clamp and the styptic clamps 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 a surgical needle. How to hold a Gegar needle holder in your hands?

Purpose of the Gegar needle holder: fixation of the needle for easy suturing and avoiding touching the tissues with fingers.

Gegar needle holder device: are 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 the friction between the needle and the jaws and to firmly fix the needle (Fig. 2.14).

Rice. 2.14. Needle holder Gegara.

Threading a 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 - 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 together 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. In this case, 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.

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 health care... - M .: Great Russian Encyclopedia. 1994 3. encyclopedic Dictionary medical terms... - M .: Soviet encyclopedia... - 1982-1984.

See what "Troyanova 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 ... Comprehensive Medical Dictionary

Scalpels Surgical instrument specially made instrument for use during surgical procedures. Contents ... Wikipedia

- (1849-1916), surgeon. Works on skin burns, surgical treatment varicose veins veins and others. He was the first in Russia to remove the gallbladder with acute perforation (1896). A number of surgical symptoms are named after Troyanov ... Big Encyclopedic Dictionary

Needle holder- a 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. Balance of the structure, excluding the occurrence of a "lever" effect.

Design features of 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, and 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;
- cruciform notches (fig. 51).

Rice. 50. Elements that make up the structure 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.

Rice. 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 from 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 of action, and stable position of the needle without deforming it. To perform the necessary manipulations, both needle holder handles usually end with rings.

In most designs of needle holders, the rings are oval in shape and the same parameters. However, on some models, the ring for thumb, is large 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;
- 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).

Rice. 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 sewing. 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 needle holder by Mathieu and Troyanov 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 make it difficult to use these needle holders in modern surgery (Fig. 53).

Rice. 53. Mathieu needle holder (after: Medicon instruments, 1986).

In practice, Gegar needle holders with handles of various lengths are most often used. 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 movements of the handles. 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).

Rice. 54. Gegar's needle holder (after: Medicon Instruments, 1986 [/]).

A prerequisite for 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 structure. Fastening 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 should be fixed with 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 curvature, minimizing trauma to the tissue.

Rice. 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 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-like shape (Fig. 56).

Locks can be used to fix the handles in a certain position original designs(Figure 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. How to work with a microsurgical needle holder:

Rice. 56. Needle holders for suturing tissue in the depth of the wound (after: Medicon Instruments, 1986):
a - curved Cliner needle holder; b - curved Finochetto needle holder.

Rice. 57. Hook-lock needle holders (after: Medicon Instruments, 1986):
a - needle holder with "hook lock" Arruga; b - a needle holder with a "hook lock" Potts - Smith.

Rice. 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 guidance.

2. When performing particularly precise movements with the microsurgical needle holder, the surgeon's forearms must 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

Selecting a suitable needle holder is important point high-quality operation. Convenience is the main thing that guides the surgeon when choosing medical instrument... Currently, there are more than 30 models of needle holders that provide stitching of fabrics in different conditions... When selecting the right kind the needle holder must be guided by the size of the needle and the features of the intervention. The surgeon's hand together with the needle holder forms complex structure for high precision actions. Therefore, it is so important to hold a high-quality and convenient tool in your hand.

Needle holder is a surgical instrument that is used to guide through tissue when suturing.

Needle holders must strictly comply with the requirements for them:

• Reliability of fixation of the needle in the working part of the instrument
• Easy to grip and release the needle
• Ensuring the accuracy of the needle at all stages of suturing
• Avoiding the "chopping effect" when fixing the needle
• Versatility when joining fabrics with different properties
• Harmonious design that does not allow for a "lever" effect
• 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 instrument
• Confident position in the surgeon's hand
• Full compliance with all ergonomic requirements
• Maintaining performance properties for a long time

In line with design features, the working ends of the needle holder should be short, massive and blunt. Cuts on them can be in the form of longitudinal grooves, transverse or cruciform notches. The notches can be replaced with a "diamond" coating, which is applied as a monolayer.

The working parts of the needle holder are called jaws. Their design can be either one-piece or in the form of removable parts made of soft alloys. A special lock, rack, fixes the handles of the needle holders in a given position. Some types of needle holders do not have such a lock, and the handles are held with closed fingers. Needle holders without a lock are used when working with atraumatic needles. To perform the necessary manipulations, the two handles usually end in rings.

Most designs of needle holders are oval in shape and with the same parameters. There are also models in which the thumb ring has more large sizes, and the handle is somewhat shorter.

The position of the standard needle holder in the surgeon's hand should be as follows:

• phalanges of I and IV fingers are inserted into the rings of the needle holder;
• the tip of the second finger fixes a place near the axis of the crossing handles.

It turns out that the fingers form a triangle shape. It is not recommended to thread the nail phalanges of the I and II fingers into the rings of the needle holder, since the axis of rotation will pass through the ends of the fingers, as a result of which the position of the needle holder will be unstable.

In practice, applied different sizes needle holders depending on the area of ​​surgery. For example, a microsurgical needle holder differs from a conventional one in the presence of a spring surface and the size work surface, the length of which does not exceed 1 cm, and the width is 1 mm. A vascular needle holder is used to apply a vascular suture. Its total length is about 100-200 mm, and its width is 1-1.5 mm.

As you can see, there are many options for needle holders, different in structure and field of application. The main ones are the needle holders of Gegar, Mathieu, Troyanov, Barraker and Codivilla.

Needle holder Gegara- classic straight needle holder. It has different lengths and widths of the handles, as well as different notches on the branches. Gegar needle holders are often used with handles of different lengths.

Codivilla Needle Holder used to hold straight surgical needles while suturing tendons. It has a complex bend in one of the handles, which increases the convenience of handling the tool.

Barracker Needle Holder used in eye microsurgery. It is distinguished by the presence of hemispherical indentations at the ends internal surfaces jaws, due to which the needle is held at any angle to the axis.

Zanda Needle Holder serves to hold the ophthalmic surgical needles when suturing. It is a combination of tweezers with a clamp, and one branch of the instrument is common to them.

The Langenbeck needle holder is a needle holder with lead plates on the working jaws, which provides a more reliable fixation of the needle.

Needle holder Mathieu used to hold the surgical needle while suturing. It is equipped with springy handles and a ratchet lock, which opens with further compression of the handle.

Needle holder Troyanov serves to hold the surgical needles when suturing. The fixing ratchet is located at the end of the handles, so it is unbuttoned with the V finger of the hand.

Needle holders Troyanov and Mathieu have such a design of the handles, the fixation of which is carried out by squeezing the fingers of the hand. At the same time, the tool lock rests against the palm, which does not exclude the possibility of damage to surgical gloves and even the surgeon's palm. Such disadvantages make it difficult to use these needle holders in surgery.

So, the choice of a needle holder in to a greater extent due to the size of the needle and the characteristics of the intervention. The more delicate and technically difficult the operation, the more graceful the needle holder should be. The smaller the needle, the smaller the presser foot should be. The needle holder is an extension of the surgeon's hand, therefore a high-quality needle holder will increase the chances of a successful outcome of the operation and reduce the likelihood of complications.

The phrase "needle holder Gegara (Hegara)" was heard by a few, only those who are quite familiar with medicine, or rather, with surgery. But the common man is also interested to know 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 Troyanov, 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 the development of surgery, medical practitioners have developed several designs of such surgical instrument... They differ in some of the characteristics of its various parts.

Many global companies engaged in the production of medical equipment and instruments, they also produce a surgical instrument, 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 made mainly of high quality of stainless steel medical purposes.

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 procedures. But whatever it is, its quality must be impeccable. What are the requirements of surgeons for such an instrument?

• absolute accuracy during 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, effective 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;
• balanced design, 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 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, 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, which 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 size than the neighboring one.

The surgeon uses great amount instrument - main or auxiliary. 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.