Which scissors are most appropriate for delicate tissue dissection during surgery?

Metzenbaum scissors. Metzenbaum scissors are designed for delicate tissue dissection. They have long shanks and short, fine blades ideal for separating and cutting fine tissues. Mayo scissors are heavier and used for cutting suture, fascia, and tough tissue. Never use Metzenbaum scissors to cut suture, as this dulls the delicate blades.

A surgeon needs to grasp a segment of bowel atraumatically. Which instrument should the surgical technologist pass?

Babcock clamp. The Babcock clamp has smooth, fenestrated (windowed) tips that provide a gentle, atraumatic grip on delicate tissues such as bowel, fallopian tubes, and ureters. The Kocher has teeth (traumatic), the Allis has interlocking teeth (semi-traumatic), and the Kelly is a hemostatic clamp not designed for tissue holding.

When passing a scalpel to the surgeon, the surgical technologist should:

Pass it handle-first with the blade facing down and away. The scalpel is passed handle-first with the blade facing DOWN and AWAY from both the surgical technologist and the surgeon. This protects both team members from an accidental cut. The pass should be firm and decisive so the surgeon can feel the instrument arrive in their palm.

The difference between a Kelly clamp and a Crile clamp is:

The Kelly has serrations only on the distal half; the Crile is fully serrated. The Kelly clamp has transverse serrations only on the DISTAL half of the jaws, while the Crile clamp is FULLY serrated from tip to hinge. This is one of the most commonly tested instrument identification questions. Both are hemostatic clamps, but this distinction helps identify them.

A #11 scalpel blade has which shape?

Pointed, triangular blade. The #11 blade is pointed and triangular (lance-shaped). It is used for stab incisions, such as creating incisions for drain insertion or arthroscopy portals. The #10 blade is rounded with a large belly (for trunk incisions), the #15 blade is small and curved (for precise incisions), and the #12 blade is hooked/sickle-shaped (for tonsillectomy).

Key Takeaways

Surgical instruments are classified into categories: cutting/dissecting, clamping/occluding, grasping/holding, retracting, and suturing
Cutting instruments include scalpels, scissors (Mayo, Metzenbaum), and electrosurgical devices
Mayo scissors are heavy scissors used for cutting suture and heavy tissue; Metzenbaum scissors are delicate for fine tissue dissection
Clamps include hemostats (mosquito, Kelly, Crile), Kocher (toothed), and Allis (traumatic grasping)
Retractors can be handheld (Army-Navy, Richardson) or self-retaining (Balfour, Weitlaner, Bookwalter)
Instruments are passed handle-first to the surgeon in a firm, decisive manner
The surgical technologist should anticipate the surgeon's needs based on the procedural steps
Instruments must be cleaned of blood and debris during the procedure using a moist sponge

Surgical Instruments & Handling

The surgical technologist must be able to identify, handle, assemble, and pass hundreds of surgical instruments. This knowledge is fundamental to efficient OR performance.

Instrument Classification

1. Cutting & Dissecting Instruments

Instrument	Description	Use
#10 blade	Rounded, large belly	Skin incisions on trunk
#15 blade	Small, curved	Precise skin incisions, small areas
#11 blade	Pointed, triangular	Stab incisions (e.g., drain sites)
#12 blade	Hooked/sickle-shaped	Tonsillectomy
#20 blade	Larger #10	Large skin incisions
Mayo scissors	Heavy, blunt or blunt-sharp	Cutting suture, fascia, heavy tissue
Metzenbaum scissors	Delicate, longer shanks	Fine tissue dissection
Bandage scissors	Angled tip with blunt lower blade	Cutting dressings and bandages
Iris scissors	Very small, delicate	Ophthalmic and plastic surgery

2. Clamping & Occluding Instruments

Instrument	Description	Use
Mosquito hemostat	Very small, delicate serrations	Clamping small vessels
Kelly clamp	Medium, serrations on distal half	Clamping medium vessels
Crile clamp	Similar to Kelly, fully serrated	Clamping tissue/vessels
Kocher clamp	Heavy, transverse serrations + teeth	Grasping tough tissue (fascia)
Allis clamp	Interlocking teeth at tips	Grasping tissue (traumatic)
Babcock clamp	Smooth, fenestrated tips	Grasping delicate tissue (bowel, fallopian tubes)
Satinsky clamp	Angled, partially occluding	Vascular partial occlusion
Bulldog clamp	Spring-loaded, small	Temporary vessel occlusion

3. Grasping & Holding Instruments

Instrument	Description	Use
Tissue forceps (toothed)	Rat-tooth tips (1x2 or 2x3)	Grasping skin, fascia
Smooth forceps (Adson)	No teeth, serrated tips	Handling delicate tissue
DeBakey forceps	Atraumatic serrations	Vascular tissue handling
Russian forceps	Round, cupped tips	Grasping tissue (general)
Bonney forceps	Heavy toothed	Grasping bone, heavy tissue
Sponge stick (Forester)	Ring clamp holding sponge	Prep, sponging
Towel clip (Backhaus)	Penetrating, sharp points	Securing drapes, towels

4. Retracting Instruments

Instrument	Type	Use
Army-Navy	Handheld, double-ended	Superficial retraction
Richardson	Handheld, right-angle	Abdominal retraction
Deaver	Handheld, deep curved	Deep abdominal retraction
Ribbon/Malleable	Handheld, bendable	Customizable retraction
Balfour	Self-retaining	Abdominal wound retraction
Weitlaner	Self-retaining	Superficial wound retraction
Bookwalter	Self-retaining, table-mounted	Major abdominal retraction
Gelpi	Self-retaining, pointed	Orthopedic/neurosurgery

Instrument Handling & Passing

Passing Technique

Pass instruments handle-first into the surgeon's palm in a firm, decisive manner
The surgeon should be able to use the instrument immediately without repositioning
Curved instruments: Pass with the curve facing the direction of use
Scalpel: Pass with the blade facing DOWN and away from both you and the surgeon, handle-first
Scissors: Pass with the tips closed, handle-first
Suture on a needle holder: Pass with the needle point facing up and away, needle holder handles toward the surgeon

Anticipation

The surgical technologist should:

Know the steps of the procedure and have the next instrument ready
Watch the surgical field, not just the back table
Listen for verbal and visual cues from the surgeon
Maintain instruments clean and organized throughout the case

CST Certified Surgical Technologist Exam

1Introduction: CST Exam Overview

2Chapter 1: Perioperative Care — Preoperative Preparation

3Chapter 2: Perioperative Care — Intraoperative Procedures

4Chapter 3: Postoperative Procedures & Ancillary Duties

5Chapter 4: Basic Science

6Chapter 5: Exam Strategy & Practice