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INSTRUMENTS

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Surgical instruments are designed to extend the capability of a surgeon's hands and thus are crafted to retract, cut, grasp, and clear the operative field. Tissue types encountered in obstetric surgery vary, and accordingly, so too do the size, fineness, and strength of the tools chosen for a given procedure. Once an instrument is selected, traditional handling strives to maximize its efficiency.

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Scalpel and Blades

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Typical surgical blades used in obstetric surgery are pictured in Figure 2-1 and include no. 10, 11, 15, and 20 blades. Blade anatomy includes the edge, sometimes referred to as the "belly." The unsharpened ridge that lies opposite to the edge is the spine. Last, the slot is the opening within the blade that allows it to be articulated and secured to the knife handle.

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FIGURE 2-1

Surgical blades commonly used in obstetric surgery.

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With surgical blades, function follows form, and larger blades are used for coarser tissues or larger incisions. For example, the no. 20 blade offers a long edge, which is ideal for quickly covering distance during initial skin incisions. The small no. 15 blade is selected for finer incisions. The acute angle and pointed tip of a no. 11 blade can easily incise tough-walled abscesses for drainage, such as those of the Bartholin gland duct.

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When the scalpel is correctly held, the surgeon can direct blade movement. Two methods are shown in Figure 2-2. If the scalpel is held like a pencil, this is termed the "pencil grip" or "precision grip." If the fingers are positioned to straddle the scalpel, this is termed the "power grip," "violin grip," or "bow grip." These grips maximize the use of the knife edge.

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FIGURE 2-2

Scalpel grips. A. Scalpel is held as one would a pencil, and movement is directed by the thumb and index finger. B. Scalpel is held between the thumb and third finger. The end of the blade is forced up against the thenar muscles of the hand. (Reproduced with permission from Balgobin S, Hamid CA, Hoffman BL: Intraoperative considerations. In Hoffman BL, Schorge JO, Bradshaw KD, et al (eds): Williams Gynecology, 3rd ed. New York, McGraw-Hill Education, 2016.)

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With the no. 10 and no. 20 blades, the scalpel is held at a 20- to 30-degree angle to the skin and is drawn firmly along the skin using the arm with minimal wrist and finger movement. This motion aids cutting with the full length of the scalpel edge and avoids burying the tip. In general, a surgeon cuts toward him- or herself and from nondominant to dominant sides. The initial incision should penetrate the dermis, maintaining the scalpel perpendicular to the surface to prevent beveling ...

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