3.2 Surgical Instrument Identification & Categories
Key Takeaways
- Surgical instruments are categorized by function: cutting/dissecting, clamping/occluding, grasping/holding, retracting, suctioning, dilating/probing
- Cutting instruments include scalpels, scissors (Mayo, Metzenbaum, iris), osteotomes, chisels, and curettes
- Clamping instruments include hemostats (mosquito, Kelly, Crile), towel clips, and vascular clamps
- Grasping instruments include tissue forceps (Adson, DeBakey, Russian, Allis, Babcock, Kocher)
- Retractors are self-retaining (Balfour, Weitlaner, Gelpi) or hand-held (Army-Navy, Richardson, Deaver)
- Instruments are typically named after their inventor, function, or anatomical area of use
- CS technicians must be able to identify instruments to assemble correct surgical sets
- Tray/set lists define exactly which instruments belong in each surgical tray
Last updated: March 2026
Surgical Instrument Identification & Categories
Central Service technicians must be able to identify surgical instruments by sight and name to correctly assemble instrument trays, replace damaged instruments, and communicate with surgical teams. Instruments are organized by function into six major categories.
1. Cutting & Dissecting Instruments
Used to cut, incise, or separate tissue.
| Instrument | Description | Key Features |
|---|---|---|
| Scalpel (handle + blade) | Primary cutting instrument | #3 handle (blades 10, 11, 15); #4 handle (blades 20, 21, 22) |
| Mayo scissors | Heavy scissors for tough tissue (fascia, suture) | Straight or curved; heavy blades |
| Metzenbaum scissors | Delicate dissecting scissors | Longer shanks, shorter delicate blades |
| Iris scissors | Very fine scissors | Used in eye, plastic, and microsurgery |
| Bandage scissors | One blunt tip to slide under bandages | Angled blade to protect skin |
| Osteotome | Bone cutting instrument | Beveled on one side; struck with mallet |
| Chisel | Bone cutting/shaping | Beveled on both sides |
| Curette | Scraping instrument | Loop or scoop shaped; sharp or dull edges |
| Rongeur | Bone nibbling/biting | Spring-action handles; sharp cups |
| Dermatome | Skin harvesting | Electric or manual; adjustable depth |
Scalpel Blade-Handle Compatibility:
- #3 handle: Fits blades #10, 11, 12, 15 (smaller procedures)
- #4 handle: Fits blades #20, 21, 22, 23 (larger incisions)
- #7 handle: Fits same blades as #3; longer, thinner handle for precision work
2. Clamping & Occluding Instruments
Used to compress blood vessels, tissue, or objects to control bleeding or hold structures.
| Instrument | Description | Key Features |
|---|---|---|
| Mosquito hemostat | Smallest hemostatic clamp | Fine tip; curved or straight |
| Kelly clamp | Medium hemostatic clamp | Serrations extend halfway down jaws |
| Crile clamp | Medium hemostatic clamp | Serrations extend full length of jaws |
| Rochester-Carmalt | Large crushing clamp | Longitudinal serrations with cross-hatching at tip |
| Kocher clamp | Heavy clamp with teeth | 1x2 teeth at tip for firm grip |
| Towel clip (Backhaus) | Secures drapes to patient/field | Sharp, penetrating tips |
| Allis clamp | Traumatic grasping clamp | Interlocking teeth; used on tissue that will be removed |
| Babcock clamp | Atraumatic grasping clamp | Smooth, curved fenestrated jaws |
| Bulldog clamp | Small vascular clamp | Spring-action; temporary vessel occlusion |
Kelly vs. Crile — The Common CRCST Question:
- Kelly: Serrations on half the jaw length (from tip to midpoint only)
- Crile: Serrations on the full jaw length (tip to box lock)
3. Grasping & Holding Instruments (Forceps)
Used to grasp, hold, or manipulate tissue during surgery.
| Instrument | Description | Key Features |
|---|---|---|
| Adson forceps | Delicate tissue forceps | Available with or without teeth (1x2 or smooth) |
| DeBakey forceps | Atraumatic vascular forceps | Fine, atraumatic serration pattern |
| Russian forceps | Broad-tipped tissue forceps | Round, cupped tips with serrated edges |
| Bonney (T-shaped) forceps | Heavy tissue forceps | Large teeth for dense tissue |
| Bayonet forceps | Offset/angled forceps | Used in nasal and neurosurgery |
| Sponge forceps (ring) | Hold sponges for prepping/blotting | Ring-shaped tip |
Forceps Classification:
- Toothed forceps (with teeth): Provide firm grip; used on tissue that will be removed or when secure grip is needed
- Smooth/non-toothed forceps: Atraumatic; used on delicate tissue that must not be damaged
- Thumb forceps: Operated by squeezing (no ratchet)
- Ring forceps: Have ring handles and may have ratchets
4. Retracting Instruments
Used to hold tissue aside to expose the surgical field.
Hand-Held Retractors (require someone to hold):
| Instrument | Description |
|---|---|
| Army-Navy | Small, double-ended, general purpose |
| Richardson | Medium, curved blade; abdominal |
| Deaver | Large, curved blade; deep abdominal |
| Malleable (ribbon) | Bendable to custom shapes |
| Senn | Small, double-ended (sharp/blunt + rake) |
| Skin hooks | Sharp hooks for skin edge retraction |
Self-Retaining Retractors (hold themselves open):
| Instrument | Description |
|---|---|
| Balfour | Large abdominal; center blade + lateral blades |
| Weitlaner | Small to medium; sharp or blunt prongs |
| Gelpi | Small; single-pointed prongs; orthopedic |
| Bookwalter | Large, ring-based system; abdominal/pelvic |
| Lone Star | Elastic stays with hooks; perineal/anorectal |
5. Suctioning Instruments
| Instrument | Description |
|---|---|
| Yankauer suction | General purpose; rigid; tonsillar tip |
| Poole suction | Abdominal; perforated outer sleeve for large fluid volumes |
| Frazier suction | Fine, angled tip; neurosurgery, ENT |
| Baron suction | Similar to Frazier; smaller |
6. Other Important Instruments
| Category | Instruments |
|---|---|
| Needle holders | Mayo-Hegar, Castroviejo, Ryder (vascular) |
| Dilators/Probes | Hegar uterine dilators, Bakes common duct dilators, lacrimal probes |
| Specialty | Kerrison rongeur (spine), Cottle elevator (nasal), Penfield dissectors (neuro) |
Assembling Instrument Trays
Using Set/Tray Lists:
- Every surgical tray has a standardized set list (also called pick list or count sheet)
- The set list specifies exact instruments by name, quantity, and sometimes catalog number
- CS technicians must match instruments to the set list precisely
- Missing or incorrect instruments can delay surgery and compromise patient safety
- Any deviations from the set list should be documented and reported
Test Your Knowledge
The KEY difference between a Kelly clamp and a Crile clamp is:
A
B
C
D
Test Your Knowledge
Which retractor is self-retaining and commonly used in abdominal surgery with a center blade?
A
B
C
D
Test Your Knowledge
A #3 scalpel handle is compatible with which blade numbers?
A
B
C
D