 First this instrument which you see on my left hand is supposed to be held in the left hand. It's called the thumb forcips Now there are two types of thumb forcips The one which you're seeing here is called a toothed thumb forcips because as you can see the end has got a small opposing set of teeth There's another thumb forcips which is not available here right now. That is called a Plain thumb forcips. So the question is when do we use the tooth and when do we use the plain thumb forcips? The toothed thumb forcips is for a better grip So it is used for structures like the skin or tough structures like opening the fascia Like the linear alba. Those are tough structures. So you need to have a good grip. That's where you use the toothed thumb forcips This what you're seeing here is a plain thumb forcips It does not have a deep. Instead it has got just a small thing here so that you know exactly how much you press This plain thumb forcips is used for holding delicate structures like for example Peritonium Misentry interesting when you're switching these you don't want to traumatize them with this In fact, if you try to hold the misentry with this the moment you hold it be tear through Peritonium is very delicate. So for those structures, you need a plain thumb forcips Okay, having said that for the henceforth We are going to use the toothed thumb forcips because we are assuming that this is the skin So this is supposed to be held in the left hand and this is the correct way to hold it The thumb should be on top. That's why because the pressure is applied to the thumb and that's how you hold the structures Some people prefer to hold it like this. I've noticed This is how you pick up the structure you just grab it and lift it up You can see how you get a good stable stable grip with this Okay, then we come to the next instrument the needle holder After I've shown you the needle holder though, we don't have the hemostat I'm going to tell you how it looks like this but how it's different from a needle holder first Let's take the needle holder It's called a needle holder because for simple reason it holds a needle between its jaws So these are the jaws of the needle holder. This is the fulcrum. It's called the box type of joint These are the limbs of the needle holder and these are the two handles How to hold it the ring finger will go in through the lower loop The thumb will go through the upper loop Your middle finger will give support from here and your index finger will control it from the side So this is how we are supposed to hold the needle holder How is the needle holder different from a hemostat because in your tray you will find hemostats Hemostat will also look very much like this, but there will be certain very crucial differences First of all the hemostat the jaws will be very long The box type of joint will be somewhere here The hemostat the jaws will be very long and the limbs will be smaller It will be more delicate than this and it's called a hemostat because it is meant for catching small blood vessels Especially the one which is curved the tip will be slightly curved so that what you can do is you can literally pick up a small bleeding blood vessel Clip it so that you can tie it That's why it's called a hemostat There are very steps of hemostats We will not go to the details the smallest one needs to call it the mosquito hemostats because it is so small It's just four and a half inches long But then we can just pick up a blood vessel and then we used to call it as catching RBCs So anyway, so that's the difference between a needle holder. Now, let's see how to hold a needle with a needle holder So this is a curved needle with Suture suture already swaged in it in the earlier days This had an eye and the nurse used to put a thread through it, but nowadays it's all there for us Depending on what thickness of the tissue that you're suturing either you hold it at the junction of the media two-thirds and latter one Third or at the junction of the media one-third lateral two-thirds That is the place to hold it The tip of the needle holder should be Let's assume it. It's a bit holding it here This is a ratchet Now the ratchet will make three clicks one two three Depending on how tight a grip you want Generally for most cases two clicks are sufficient generally So what I'm going to do is I'm going to hold the needle here just to show you and you see One two two clicks The axis of the needle and the axis of the needle holder should be at 90 degrees It should not be this It should not be like this all these things The axis of the two the long axis of the needle and the long axis the needle holder as you can see This is the long axis and this is the long axis there at 90 degrees and Usually two clips two clicks are sufficient. We don't usually need three clicks If you make too many clicks then sometimes it becomes difficult especially Lady surgeons, I mean their fingers are delicate, right? Sometimes they have difficulty Unhooking it in one click, you know, so that's why it is better advice able to do it and just two clicks Sometimes even one click is sufficient If you make very loose if you just put one click sometimes what happens the needle wobbles So for all these reasons generally speaking as I said two clicks are sufficient It will not wobble it'll be more stable Now let's come to the needle itself There are two types of curved needles. One is called a straight Cutting needle and one is called a round-bodied needle. Now. What is the difference between a cutting and a round-bodied needle? It is determined by the cross-sectional the hammy the appearance Suppose I were to imagine that I've cut the needle across like this Just imagine and if I were to look at the cut end of the needle from that side What is the appearance of the cutting? if the cut end looks like this That means it is like a triangle With the apex of the triangle towards the concavity and the base of the triangle towards the convexity That is called a cutting needle What does it mean? It means that it is meant for tough structures again like the skin it cuts through the skin very smoothly and You will see from your experience that for tough structures. You do need a cutting needle Then where do we use the round-body needle round-body needle again if you're able to take a cut section like this I'm going to look at it from the end. How will it look like? It will look like a perfect circle That's called a round-body needle Where do we use the round-body needle again? We use it for delicate structures like the peritoneum, the miscent free, the intestine and all these structures And if you were to try to use a round-body needle for a skin, trust me It would be very difficult because though we may think the skin is very thin The human skin is really really very tough structure especially the dermis has got a lot of collagen and elastin fibrous tissue and We do need a cutting needle for that round-body needle. It just does not go through the skin It just refuses to work just keeps wobbly here and there. So there are four for tough structures We need a cutting needle. So these are the basic instruments That leaves us with the final one the scissors You know what the saying is surgeon is the only person in this world who can cut straight with the girls scissors There are two types of scissors This what you see here is the straight scissors This is the Taylor scissor or the grandmas scissor This is meant for cutting thread This is not meant for cutting tissue Straight scissors are meant for cutting thread. It is not meant for cutting tissues The scissors with the surgeons used to cut tissues will be curved like this That's why we said surgeon is the only one who cuts straight with a curved scissor Curved scissors are used for cutting tissues like for example after we have made the incision on the skin And the lini alba and when we want to cut the peritoneum the surgeon is standing on the right side of the patient So you see suppose this is the patient You made the incision The what would if suppose I could you use a straight scissor then what I have to do is I have to go like this and cut Isn't it but if the end is curved and what I can do is I can stand here and I can cut like this That is why we said the surgeon is the only one who cuts straight with a curved scissor So curved scissor is meant for cutting tissues straight scissor is meant for cutting With thread. So these are the basics of the instrument you can stop it rolling now