MOUTH GAG

      A mouth gag is any kind of device used to hold the mouth open or to keep the wearer from speaking. Mouth gags can vary widely in design and can be made of anything from rubber balls to stainless steel. They are used in dentistry and surgery in order to hold a patient's mouth open. A mouth gag may also be used in adult erotic play.

A mouth gag can assist in keeping a patient's mouth open if he has been sedated for painful dental work or surgery. It can also help patients who have difficulty keeping their mouth open for other reasons. When placed in the mouth, the mouth gag keeps the teeth apart while still allowing for a surgeon or dentist to work inside.

Dental mouth gags are usually made of stainless steel so that they can be easily cleaned and sterilized. They usually consist of a thick metal wire shaped into a rough oval, which is placed inside the mouth. Some other kinds of mouth gags resemble a pair of pliers, which can be locked in an open position to hold the mouth open on one side. 

A surgical mouth gag is used to keep a patient's mouth open while they are sedated and unconscious. Some surgical mouth gags come with built-in steel tongue depressors in order to hold a patient's tongue in place. This allows for the surgeon to have easier access to the throat. Surgical mouth gags are used during operations on adenoids, tonsils, and other surgeries which require access to the throat.

Mouth gags used in erotic play have a different purpose than those used in dentistry or surgery. Instead of holding the mouth open, they are used to keep the wearer from speaking clearly. Though they seldom are made well enough to keep someone from making noise, they can provide a powerful visual in games of power exchange. 

Erotic mouth gags are often made of materials that can be bitten into without harming the wearer. To this end, they often take the form of a soft rubber ball. The ball is held in the mouth by a strap that passes around the head. In some designs, the ball can be taken off the strap for easy sterilization. 

These gags can also take the form of simple strips of tape or cloth which go over the mouth or between the teeth. To further block the mouth, a piece of cloth might be stuffed inside the mouth before putting the gag over the wearer. This kind of simple gag can usually be defeated by movements of the tongue, which can push the fabric out of the way.

EAR SYRINGE

     An ear syringe is a medical device that is used to introduce or remove fluids from the ear. The design is also known as a bulb syringe and it can also be used in the nose. Ear syringes are available at many drug stores and they can also be obtained through a doctor's office. If a doctor prescribes a treatment that requires this device, one may be provided or packaged with the treatment for the convenience of the patient.

These devices consist of a rubber bulb attached to a short tube. They can be disposable or designed for multiple uses. By compressing the bulb to squeeze the air out, people create a pressure differential inside the syringe. When the tube is inserted into the ear or nose and the pressure is released, the syringe will suck up fluids, such as water and mucus. The same technique can be used when dipping the syringe into a fluid being used for treatment to fill it up.

A common reason to use an ear syringe is to clean out the ear. Syringing the ears after swimming, surfing, and engaging in other activities in the water can reduce the risks of inflammation and infection by keeping the ear as dry as possible. In addition, the syringe can be filled with a fluid solution to break up ear wax for the purpose of removing wax from the ears.

Care must be taken when squirting fluids into the ear with an ear syringe. Although the pressure is not very high, it can potentially damage the ear drum and cause hearing loss. It is also important to thoroughly syringe all of the fluid out afterward. The process can also be messy. People are usually advised to hold their heads over a towel to catch drips and overflow.

If an ear syringe is going to be reused, it needs to be cleaned after each use. It may also be advisable to limit use to a single person to reduce the risk of spreading infections. Cleaning is accomplished by filling the syringe with an antibacterial solution, such as a blend of alcohol and water or hydrogen peroxide and water and then squeezing the fluid out to flush the ear syringe.

Ears should not be flushed if there is a foreign body inside, if someone cannot hear from the affected ear, or if the ear is painful. Instead, a doctor should be consulted to clean and examine the ear.

ATRAUMATIC / DEBAKEY Froceps

      Debakey forceps are a type of surgical forceps used to hold vascular vessels and tissue. They are specifically known for being atraumatic, or non-damaging. They are capable of holding soft tissues, blood vessels, and other delicate body parts without causing harm. By squeezing the blades, surgeons are able to capture tissues between the blunt tips and hold them in order to perform surgical operations or hold the tissues out of harm's way. A common nickname for Debakey forceps is magics or magic forceps.

Often resembling standard tweezers in design, Debakey forceps are one of the most widely used pieces of surgical equipment, especially in cardiovascular surgery. The blades consist of two flat pieces of metal connected at one end so that the blades point away slightly from each other in a narrow A-shape. Squeezing the blades together creates spring tension so that the tips can grip. Debakey forceps usually require a specific spring tension to allow for easy opening and closing without undue force that could damage sensitive tissues.

The blades will either taper gradually down to a thin, straight tip or truncate with the slender cylindrical tip attached. Most have ridged blades to provide traction for gripping. The tips have a very specific design — the interior surface of the slim, blunt-ended tips features microscopic teeth designed to fit together on closing. These teeth grip blood vessels or other tissues with enough friction to provide a firm hold without damaging them. 

The forceps are generally crafted from stainless steel or other surgically-safe, easily-sanitized material. Straight forceps average 4.75 inches (12 cm) in length, but can be up to 9.5 inches (24 cm) long. Depending on the use, such as intestinal forceps, the design may vary to include different sizes or even curved blades. Many forceps also use hybrid designs pairing Debakey dips with other models, such as the Debakey-Satinsky forceps or the Allis-Debakey forceps. These can be paired with forceps clamps to grip delicate tissues during suturing and other procedures.

Debakey forceps are named after Michael E. Debakey, a pioneer in medical science and development. He made several groundbreaking discoveries in surgical medicine, including techniques in blood vessel grafting, replacement, and repair. He also invented devices such as the roller pump, the first successful external heart pump — and of course, the Debakey forceps, which were originally designed for vascular surgery. Debakey also introduced the practice of video-recording surgical procedures.

MAGILL Forceps

      Designed by the physician Sir Ivan Whiteside Magill in the 1920s, Magill forceps are one of several tools that aided in the development of modern anesthesia. The tool combines long forceps with an angled handle, which keeps the hand out of the line of vision when a physician is inserting or removing tubes from the trachea or esophagus. Magill forceps also are used to remove small objects from the throat or mouth.

Also known as Magill’s forceps, Magill forceps come in several standard sizes. In addition to a 9.5-inch (24-cm) size used for adults, there’s also a 7.5-inch (19-cm) size for use on children. An extra-small size of 6 inches (16 cm) is used for babies. These various lengths allow physicians to use the proper length of instrument depending on the patient’s size. Like many medical tools that are inserted into the body to perform a task, Magill forceps are made of stainless steel, which makes them easy to clean and sterilize.

The history of Magill forceps goes back to World War I. Born in 1888 in Ireland, Magill developed his approach to anesthesia after seeing accidental battlefield deaths caused by anesthesia overdosing. At that time, patients were anesthetized using a rag soaked with chloroform. The chances of overdose were great with this inexact administration.

Magill recognized a need for equipment inserted into patients' throats so they could be anesthetized continuously and safely throughout surgery. On his way to achieving this goal, Magill developed many tools, including tubing for the throat and nose, the Magill forceps for inserting and removing the tubing and a rudimentary breathing system that eventually evolved into modern-day anesthesiology systems.

With their curved handle and ease of operation, Magill forceps soon became useful for removing objects from the airways. They have been used in emergency rooms and critical-care centers to extract small toys or toy pieces swallowed by children. Medical literature has recorded the use of Magill forceps to retrieve something as small as a safety pin from the upper esophagus of a child.

Magill forceps also have been used to insert throat packs prior to oral surgery. Made of a porous, sponge-like material, throat packs are used to absorb blood and other fluids and keep them from entering airways. An oral surgeon can use these forceps to guide a throat pack into place and, if need be, to help remove it.

OTOSCOPE

      An otoscope is a medical tool which allows doctors to look inside the ears of their patients. In some regions, the device is known as an auriscope. The simple design of an otoscope actually allows doctors to use it in several applications, not just to look into the ears. Many doctors keep an otoscope, because it sometimes becomes necessary to examine a patient's ears. The device can be obtained from many medical supply companies, since it is a commonly needed item, and otoscopes vary widely in price, with high end models commanding a high price.

The design of an otoscope is very simple. The device has a long handle, usually textured for easy gripping. At one end, the handle has a bright light and a magnifying glass. The doctor inserts a disposable speculum into the otoscope, straightens the patient's ear canal by pulling on the ear, and inserts the otoscope to look inside. In some cases, the otoscope may have a space which allows the doctor to insert tools which might be required to treat a problem.

As part of a regular exam, the otoscope is used to check the health of the patient's ears. The examination may reveal a hidden problem which should be dealt with before it becomes worse. An otoscope is also used to examine the ears of a patient when he or she has symptoms indicating a problem with the ears. Some doctors also use the device to peer into the throat or nose of a patient, usually without a speculum attached.

Since the speculum is the only part of the otoscope which should make contact with the ear, it is designed to be disposable for patient safety. The disposability also allows doctors to use different sizes, customized for ears of older and younger people. Most doctors also wipe down their otoscopes after use to ensure that nothing is passed from patient to patient.

Using a otoscope properly requires training. It is possible to damage the ear of a patient during an ear examination. It can also be difficult to identify a problem if you are not familiar with ear anatomy and health. For these reasons, patients in need of ear examinations should always go to a doctor, rather than trying to use an otoscope at home. A doctor can identify the problem and establish a course of treatment while ensuring that the integrity of the ear is maintained.

TUNNING FORKS

C-512

       A tuning fork is a tool used to provide a pure tone. It is used as a reference for accurate pitch, and to mark time in quartz digital watches. Hearing tests may employ a tuning fork, as may physics classes focusing on the study of sound.

In appearance, a tuning fork is a two-pronged metal fork that is shaped like a U and extends from a handle. Most people are familiar with the fundamental mode of a tuning fork, which is the long-lasting mode used as a standard for pitch. The so-called “clang” mode is a higher frequency and dies away very quickly.

Invented in 1711 by musician John Shore, and originally called the “pitch-fork,” the tuning fork was further developed by several inventors with an eye to providing a new type of musical instrument. This idea never caught on, however. Today, a tuning fork does have a musical use, however: it can be used to set the pitch for performers or instruments. 

For example, a tuning fork may be used by a conductor or performer to set an accurate pitch for a musical performance of an a cappella group. Often, one pitch is struck and the conductor or the various vocal parts figure out their pitch based on the struck pitch. If the piece has several movements, pitches may be given before the start of each new section.

There are other musical uses as well. A set of tuning forks, or a tuning fork for middle C and a good ear, can be used to tune a piano, although electronic tuners have become popular. Timpanists use a pitch pipe or a set of tuning forks to tune the timpani. For musical purposes, tuning forks are readily available at pitch A-440, as well as middle C, and sets are available for the notes of the C major scale as well as the chromatic scale. For medical purposes, such as testing for hearing loss, there are specialized tuning forks with the pitches needed for various, specific testing protocols. The scientific tuning fork is a specialized tool for research in acoustics and sound wave analysis and for calibrating various devices. These different types of tuning forks are not interchangeable. For example, scientific tuning forks are usually mounted, whereas musical tuning forks are handheld. A tuning fork should be carefully chosen based on the goal of using them in a musical, medical, or scientific setting.

BULLDOG Clamps

   The bulldog clamp is a surgical tool used to clamp off or close blood vessels. Made of stainless steel or titanium, the most common bulldog clamp is a spring-loaded crossover clamp. It has serrated blades that when pressed together become an effective tool to cut off blood supply.

There are clamps made for arteries and veins. The structure and function of arteries and veins are different. The arteries carry blood away from the heart. All arteries, except for the pulmonary, or the respiratory arteries, and the umbilical artery, the blood vessel in the abdomen and pelvic area that extends to the umbilical cord during pregnancy, carry oxygenated blood. Veins carry blood towards the heart. Veins carry deoxygenated blood, except for the pulmonary and umbilical arteries, which carry oxygenated blood.

The main purpose of the bulldog clamp is to stop the blood flow and prevent excessive bleeding in the area of the surgical procedure, and to prevent the patient from losing an unnecessary amount of blood. The most common type of clamp opens when the handles are squeezed, and conversely, shuts when the pressure is released from the handles. 

Slight variations to these clamps can be found, depending on the location of the surgical procedure and the needs of the surgeon. For example, the glover bulldog clamp utilizes a tension-adjusted screw to replace the standard handle-operated opening and shutting of the clamp. This tension-adjusted screw allows for a controlled amount of pressure to be placed on the blood vessel.

The bulldog clamp comes in a variety of sizes and shapes. Clamps typically range from one inch (2.5 cm), commonly used for smaller blood vessels or areas which require a delicate touch, to two inches (5 cm) in length. They can be straight or curved. The curvature of the blades can also range from curved to strongly-curved. This allows the surgeon to access those blood vessels which are difficult to reach.

The bulldog clamp can also come with an amplifier. An amplifier resembles an extended handle. This allows the surgeon to use clamping techniques when distance is an obstacle. An example of a surgical procedure where an amplifier may be needed to secure a blood vessel is endoscopic procedures. 

An endoscope is an instrument which allows the surgeon to see deep body structures and organs where there is no direct line of sight. Examples of surgical procedures that may require an endoscope are inside the colon or bowel. This is where a bulldog clamp amplifier can effectively utilize the necessary clamping techniques without difficulty.

DEAVER Retractor

     A Deaver retractor is a surgical instrument used to hold the edges of an abdominal or chest incision open so that the surgeon is able to reach the underlying organs. It is a thin, flat instrument with curved ends. The curved ends of the retractor are placed at the edges of the incision and held there by hand or clamped into place. The Deaver retractor can be used to hold organs inside the abdominal cavity away from the surgical site.

The earliest recorded use of a retractor dates back to the seventh century. The modern retractor is designed after a model developed in 1936. Deaver retractors were developed to safely hold the large organs contained inside the abdomen away from the surgical instruments used during the operation. During an operation on the thoracic region, the Deaver retractor is used to hold the flesh of the chest away from the incision or to gently move the heart or lungs at the direction of the surgeon.

Making sure the retractor is in good condition is essential to a successful operation. The surgeon will make an incision and direct the assistant to place the retractor on the flesh at the edges of the incision. This medical instrument enables the surgeon to have a clear view of the operating field. The retractor has smoothed edges to reduce the trauma to the tissue being held in place. A Deaver retractor is generally used for deep abdominal and chest surgeries.

There are several different types of retractors. Each is shaped uniquely to do the least damage to the tissue intended to be held back by the retractor. The Richardson retractor is a thin, curved medical instrument with a handle for easy gripping. It is the most common retractor used in abdominal or thoracic surgeries. It can be single or double-ended, depending on the surgical needs of the operation. 

Another commonly used retractor is the Senn retractor. It is a double-ended surgical instrument, with one side shaped like a blade and the other side having three prongs. This retractor is used for most hand and foot surgeries. The Senn retractor is used to hold soft flesh away from the surgical site for short periods of time.

Most retractors have a special handle to make holding it in position during surgery easier. Usually, the retractor is held in place by a surgical assistant instead of the surgeon. Use of a retractor enables the surgeon to perform operations faster and with more accuracy.

BONE Rongeurs

     Rongeurs are surgical instruments which are designed to chip, crack, or cut away bone and tough tissue such as cartilage. The term comes from a French word meaning “rodent,” a reference to the fact that rongeurs are designed to gnaw away at tissue and bone, under the control of a surgeon. In addition to being used in surgery, rongeurs are also employed by dentists, and they can be used in some other settings as well; for example, sometimes cooks work with tools similar to rongeurs when they are butchering meat.

The shape of a rongeur can vary. These instruments tend to have curved, sharp tips which can be used to gouge out bone. Many are designed like forceps, allowing a surgeon to grip at tissue of interest and carefully tear it away. Others are solid tools which can be used to chip bone or tough tissue to gain access to a surgical site or to clear away excess material. Some are spring loaded to create more force for gripping and tugging.

Dentists can use these tools to chip away dental tartar, and to crack it off the teeth, if necessary. Wherever they are used, rongeurs must be carefully controlled to avoid taking off more tissue or bone than one intends. These instruments are very tough and strong, and it is easy to be more forceful with them than one has intended. Users tend to err on the side of caution, working on removal of small chips instead of large pieces.

People may refer to rongeurs as rongeur forceps when they are designed in a forceps style. Other terms may be used to refer to specialized types of rongeurs. Surgeons like to have specific terms to use for the tools they need so that when they ask a surgical assistant for a tool, they can be assured that the assistant will know precisely which tool to grab.

Like other instruments used in surgery, rongeurs are designed to be sterilized. Sterilization is important, to minimize the risk of cross-contamination between patients. These tools may also be sharpenable, allowing a surgeon to send instruments out for sharpening so that they will continue to be efficient and effective. Because rongeurs can sometimes come into contact with bone marrow, there may be settings in which the instruments need to be disposed of after use. Bone marrow can house prions, rogue proteins which can cause disease and resist known sterilization techniques. Patients with prion disease or at risk of such diseases may pass these diseases on via surgical and dental instruments.

WIRE CUTTERS

   Wire cutters are a tool designed specifically for the purpose of cutting wire. There are several variations on the basic design, including versions of varying weights designed for wires of different thicknesses. Many hardware stores carry wire cutters, and they are also available through stores which stock equipment for electricians, jewelers, and other professionals who work with wires. This tool can be very useful to keep around the house, and many generic versions are available to stock home toolboxes.

Also known as snips or diagonal pliers, wire cutters are designed in a style similar to pliers, except that instead of grips, the tool has sharpened edges which cut through wire. The bigger and heavier the cutters, the heavier the gauge of wire they can handle. Wire cutters can also have insulated handles, which may be useful in some applications, and some may include a wire stripper so that people can strip and cut wire with the same tool, which is useful for electricians.

Basic wire cutters simply create a blunt cut through the wire. Flush cut wire cutters are designed for situations in which people want to create a cut as close to the edge of something as possible, allowing the cutters to be butted right up against an object to snip the wire. Bezel cutters create a slightly different edge on the end of the snipped wire, and are most commonly see in use by jewelers.

Really tough wire cutters can be used in industrial settings where heavy gauge wire is used. This type is often included in rescue kits so that first responders have a tool which they can use to quickly cut through wires on the scene of an incident, along with bolt cutters which can handle bolts, padlocks, and so forth. Such cutters often have thick, insulated handles to make them easier to handle, and some physical strength may be required to operate them.

A good pair of wire cutters can sometimes be pricey, but the price is considered worth it for a reliable tool. People can prolong the life of a pair of cutters by making sure that they are stored in a dry location and wiped down after use if they are used in wet or messy environments. It is also a good idea to periodically oil the joint of the cutters, so that they will operate smoothly and without snagging. Snagging can create rough edges which may scratch people.

UMBILICAL CORD Clamp

     In many births, it is routine to separate the baby from the placenta by cutting the umbilical cord. This procedure usually first involves clamping the cord. The umbilical cord clamp thus refers to the devices used to hold the cord in place when the cut is made, and the clamp may stay on for several days while the remaining cord attached to the baby dries.

There can be some variance in appearance of the umbilical cord clamp. Many are plastic and look slightly like a barrette. They usually have teeth that fit together as the cord is clamped, and they may have different fittings on the open side that click in place so a secure fit is achieved. Many medical companies that make the clamps are located in places like India or China, but clamps may be made elsewhere too.

Sometimes an umbilical cord clamp is sold with a cutter of some sort, and they're usually sold in volume supply. People can’t just buy one but may need to buy hundreds at a time. This may be helpful for hospitals, but could be an issue for midwives who attend home births, as they simply may not need that many clamps, or a supply might last several years at least. 

Not every child who is born has an umbilical cord clamp. Some parents cut the cord and prefer to let the whole cord fall off in the ensuing days. Other times the umbilical cord is secured by tape instead of an umbilical cord clamp. There are disputes about which procedure is most healthful.

One thing that is currently at issue is when to apply an umbilical cord clamp and when to cut the cord. It used to be standard for babies to have the clamp and cut at one minute. Now there is some evidence suggesting that waiting until three minutes may be more beneficial to newborns because it allows continued blood communication between the placenta and the newborn, which may affect blood clotting time or iron in blood levels. 

This brings up the very nature of the umbilical cord clamp. In addition to providing stability to cut the cord, it cuts off communication with the placenta. This is the natural round of life, but there are some who find this a deeply sentimental aspect of the birth of a child. The connection between mother and child on an elemental level is severed with a clamp and cut, though at the same time, birth brings the opportunity for knowing the child in ways not possible when that baby was in the womb.

MALLETS

     A mallet is a type of hammer with a large, soft head which is intended to strike a surface without causing any damage to it. Mallets typically have short handles, making them easier to control. There are a wide range of mallet styles on the market which are designed for a range of applications. Many hardware stores stock basic mallets, and it is also possible to find specialty mallets designed for particular professional trades. Some craftspeople also make their own mallets for specific tasks.

The materials used to make mallets vary. Some common choices are: wood, soft metals, rubber, plastic, and rawhide. As a general rule, mallets are designed so that the materials they are made from will deform before the mallet damages the object it hits. Many mallets are also made from resilient materials which will spring back after they are used; this allows people to use them again and again for projects, as the mallet deforms only temporarily.

Carpenters use mallets as driving tools, to hit other tools like chisels. The broad head of a mallet makes it easy to use when hitting a chisel, requiring less precision on the part of a user. A mallet may also be used to knock pieces of wood into place, or to hammer pegs into furniture and flooring. If a mallet strikes the project being worked on, the soft material simply bounces off, rather than creating a gouge as a hammer might.

Mallets are also used in metalworking and jewelry to flatten metal and drive various tools. In metalworking, mallets are often made from metals which are softer than the metal being worked. These metals can withstand the heat sometimes involved in metalworking without causing damage. Plastic mallets are also sometimes used by jewelers, and various metal mallets are sometimes utilized in machining and electronics as well.

Mallets also pop up in the kitchen. A meat tenderizer is simply a form of mallet, and some people skip the customized tool and stick with a mallet from the toolbox instead. Mallets can also be used in leatherworking, to drive the tools used to tool leather and sometimes to add texture to a leather surface as well.

Because mallets can deform, it is a good idea to hang them up so that they do not come into contact with other tools; even a small amount of pressure can create a distinctive imprint in a mallet. Many mallets have loops on their handles for the purpose of hanging, and a mallet can also be suspended from its head.

VAGINAL Speculum

Graves Vaginal Speculum

     A vaginal speculum is a medical instrument which is used to dilate the vagina for examination of the vagina and cervix. This medical instrument can also be used in examinations of the anus, although specialized anal specula are also available. Numerous medical instrument manufacturers produce vaginal specula, which are available for sale through medical supply catalogs. Some women's health centers also sell these devices to their patients, for patients who are interested in performing vaginal self exams.

Specula in general are a family of medical instruments which are used to visualize the interior of the body by inserting the instrument to get a better view. In the case of a vaginal speculum, the instrument includes a blade which is gently inserted and used to dilate the vagina to make it easier to see. Classically, doctors use a two-bladed speculum which resembles the bills of a duck, with a locking handle to manipulate the blades, although single blade vaginal specula are also available.

Clear plastic specula are preferred for examination, because it is easier to visualize the area when using a plastic speculum. These specula are disposable, designed to be discarded after use with a patient. Metal specula are also available, and must be cleaned and autoclaved between patients. Vaginal specula come in several different sizes, to accommodate women with vaginas of various sizes. Especially small versions can be used for examinations when a woman has an intact hymen.

To use a vaginal speculum, a doctor has a patient scoot down a gynecological exam table after putting her feet in a pair of stirrups. The doctor usually examines the external genitalia before having the patient take a deep breath. As she breathes out, the doctor can insert the lubricated speculum in the closed position, and gently open it before locking it in place. The device will stay in place, allowing the doctor to take samples and examine the area before unlocking the speculum and gently withdrawing it.

The vaginal speculum is held open with hand pressure while it is withdrawn, and closed only when it is completely removed. Closing the device before it is removed can pinch the delicate mucus membranes of the vagina, which can be extremely uncomfortable. It is also important to make sure that the device is fully closed when it is inserted for optimal patient comfort. Women can use the same procedure described above to perform a self exam, with the assistance of a mirror to see once they have placed the vaginal speculum.

TENACULUM Forceps

      A tenaculum is a surgical instrument which is used to grasp and hold tissues. The tenaculum is a form of locking forceps, designed to hold itself in place once it has been locked, and it can be used to hold tissues steady for surgical procedures, to hold tissues out of the way, or to grasp tissues for the purpose of manipulating them. Many companies which manufacture surgical instruments produce tenaculum forceps in a variety of styles for various uses.

This surgical instrument dates to at least the 1600s, with the name for the instrument coming from a Latin root which means “to hold,” the same root involved in words like “tenacious.” The tenaculum consists of long, narrow handles attached to hooks. The hooks can be anchored in the tissue being examined, with the medical provider locking the handles once the desired position has been obtained.

One of the most common uses of the tenaculum is in procedures when it is necessary to stabilize the cervix in order to see or perform a procedure. A cervical tenaculum may be made from plastic, designed to be single use for one patient only, or from stainless steel, in which case it can be sterilized and reused. Tenaculum forceps are also used in other types of surgical procedures.

Like other surgical instruments, the tenaculum can seem slightly barbaric in action, but the patient will not feel it when it is placed as long as he or she is under general anesthesia. In cases where the patient is awake, as for certain gynecological procedures, local anesthetics may be injected so that the patient cannot feel the placement and removal of the instrument. The patient is also usually given a medication which promotes relaxation so that he or she will feel more comfortable during the procedure.

Learning to use surgical instruments appropriately takes time. During the course of surgical training, doctors learn about the different instruments available to them, the uses recommended for various instruments, and the techniques which should be used to handle them. Although patients cannot feel instruments during surgery, poor instrument choice or use can complicate matters for the patient by inadvertently causing damage to the tissues, which can increase healing time or increase the risk of infection. Surgeons also tend to develop their own instrument technique over the course of their careers, developing various tricks and methods which facilitate their work in the operating room.

BIOPSY Forceps

Tischler-Morgan Biopsy Forceps

   Biopsy forceps are a surgical instrument that resemble a pair of scissors. They are used as a grasping tool during surgery. Biopsies are performed when a physician needs to examine tissue for disease. By testing tissue retrieved during a biopsy, physicians can diagnose patients and determine the most appropriate course of treatment, or rule out certain illnesses. During surgery, biopsy forceps can be used for delicate work. If the physician’s fingers are too large to manipulate tissue inside a small incision, these instruments will take the place of fingers. They can also act as a third hand during surgery. If several bits of tissue need to be held aside while a surgeon performs a task with his hands, biopsy forceps will be used to hold the tissue aside. 

Biopsy forceps have several different designs, each appropriate for a different surgical situation. There are two basic types: locking and non-locking. Locking forceps are used to grasp and hold tissue, while non-locking forceps are used to move tissue.

Locking forceps typically have finger loops that resemble those on a pair of scissors. The most common mechanism to make these forceps lock is a group of interlocking teeth near the finger loops. When the forceps close, the teeth lock and hold the blunt blades of the forceps closed. 

Non-locking forceps have a spring mechanism that holds the blades open until pressure is applied. They are used to quickly move small objects during surgery. Non-locking forceps can have blunt tips or lightly serrated tips. 

Biopsy forceps can be designed with straight tips or an angled shaft. The angled shaft gives surgeons a bit of extra reach during surgery and helps with easier maneuverability. The instrument may also be designed with a rotating shaft, which allows a physician to maneuver tissue deep within the body cavity without making a large incision. 

Some important qualities in biopsy forceps are sterility and durability. Typically, the instrument is made of high-grade carbon steel. This high-quality steel allows the forceps to withstand repeated sterilization, which occurs under extremely high temperatures. Sterilization between surgeries is important to prevent disease transmission from patient to patient. 

Other types of biopsy forceps are intended to be used once and then thrown away. These are typically made of plastic. There is some debate over which type of biopsy forceps, one-use or reusable, is better. Some studies have shown that one-use biopsy forceps get better tissue samples, but reusable ones have better durability.

RECTAL Speculum

Matheiu Rectal Speculum

A rectal speculum is a device that is inserted into the anus to keep the anus open for diagnostic viewing of the rectum or for anal surgery. The rectum is the last eight inches (20.3 cm) of the large intestine that culminates in an orifice called the anus. The rectum stores feces until it is ready to be excreted. Conditions that might warrant the use of a rectal speculum include detecting the presence of hemorrhoids, tumors, polyps, inflammation, intestinal bleeding, and anal fissures, conducting biopsies, and removing hemorrhoids. The speculum is typically a rigid tube or a set of blades that pushes the walls of the rectum apart so a physician can view the canal with direct vision. 

Though speculums were traditionally made of metal, today many are made of plastic. Vaginal speculums may even be made of disposable plastic for one time use, allowing doctors to skip the step of thorough sterilization between uses. There is a higher risk of disposable plastic breaking in the rectum, however, so the rectal speculum is typically still made of metal or a very tough plastic. 

The word speculum is typically associated with the vaginal speculum, a device with two handles hinged to two rounded blades. This tool can sometimes be used as a rectal speculum as well. When closed, the blades resemble the shut bills of a bird’s beak. The physician lubricates the blades with a water-soluble jelly and inserts the speculum into the anus with the blades shut. As the physician cranks the handles shut, the bills of the speculum open, allowing him or her to see inside the body cavity.

The types and sizes of speculums may vary depending on the needs of the patient. A rectal speculum may have three blades to create a wider opening and clearer viewing. A colon exam called an anoscopy requires an anoscope, or a 3-4 inch (7.6-10.2 cm) rigid tube about the width of a typical bowel movement. 

A proctoscope is similar, though it is usually made of metal, rather than a tough plastic, and is inserted deeper into the rectum. For even deeper viewing, such as during a colonoscopy, a physician may not be able to see the area with her bare eyes and choose to use an endoscope. An endoscope is a flexible tube with a lighted viewing mechanism at its end that sends images to a screen outside the body. 

A typical examination using a rectal speculum can be conducted in a doctor’s office. The patient will need to take off his underwear and assume a position that makes the anus accessible. The doctor may ask the patient to lie sideways, bend over the examining table, or sit on the table with knees tucked to the chest. Before inserting the speculum, it will be lubricated to prevent discomfort and the doctor may ask that the patient push as if trying to make a bowel movement and then sit at ease. The physician will then gently insert the speculum and shine a light into the tube to illuminate any fissures, or tears in the lining of the rectum, bulges, or other abnormalities. Often, the doctor can give the patient the results of the exam immediately.

A rectal speculum may also be used for hemorrhoid ligation. A hemorrhoid is a swollen vein in the rectum or anus. After the patient is locally anesthetized, the procedure begins by placing an anoscope or proctoscope in the rectum. The physician then places a tiny rubber band around the base of a hemorrhoid to cut off circulation. The hemorrhoid will eventually die and fall off, protecting the patient from pain, excessive bleeding, and clots.

CLAMP Forceps

     Clamp forceps are a type of tool that can hold, compress, or grasp an item while locking in place. They are also called locking forceps. For instance, clamping forceps allow a heart surgeon to clamp off an artery to prevent bleeding, while the locking mechanism keeps the forceps in place. These types of forceps are used primarily in the medical field in both veterinary and human medicine. There are many variations of sizes, materials, and designs, with some forceps engineered to perform specific functions. 

Most of these forceps are shaped like an X and use a lever principle. A hinge at or near the center of the forceps allows the user to squeeze one end to apply pressure at the opposite end. They are similar in action to ordinary scissors, except that the forceps lock in place once they are closed. The clamping, or locking, mechanism is a set of opposing serrated tabs located between the openings for the thumb and forefinger. When the clamp forceps are squeezed, the serrated tabs come into contact with each other and hold the forceps at that pressure; with another slight squeeze, the user breaks the contact, and the forceps open.

The simple locking mechanism, unlike spring clamps, allows for various clamping pressures. A light squeezing pressure can compress delicate tissues without damaging them. Stronger squeezing pressure can be used to compress surgical tubing or hold a tooth during extraction. This variable pressure feature and the ease with which they are placed, locked, and released make clamp forceps one of the most commonly used surgical instruments.

Forceps that are used to clamp off blood vessels are called hemostats. Many forceps are named for the surgeon who designed them. Surgeons sometimes develop these tools to use on specific tissues or during a particular type of procedure. Doctors use Allis forceps to hold intestinal tissue, while Carmalt forceps clamp ovarian pedicals. Adson forceps have long, tapered ends, allowing them to handle delicate tissue.

Several different materials are used to fabricate forceps. Those that are to be used once and then disposed of are made of plastic. Others are made of stainless steel or carbon steel, metals that will survive repeated sterilization. A number of specialty clamp forceps are made of titanian, a durable and lightweight metal. Depending on the use, the grasping end of the forceps may be rubber coated, angled, or grooved.