OR

Scrub nurses, also called perioperative nurses, are registered nurses who assist in
surgical procedures by setting up the room before the operation, working with the
doctor during surgery and preparing the patient for the move to the recovery room.
The website Nurses for a Healthier Tomorrow notes that scrub nurses work in
various clinical settings, including hospital surgical departments, private physicians
offices, clinics and ambulatory (also called day surgery) centers.

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Before Surgery

The scrub nurses duties begin far before the start of the operation. He ensures the
operating room is clean and ready to be set up, then prepares the instruments and
equipment needed for the surgery. He counts all sponges, instruments, needles and
other tools and preserves the sterile environment by scrubbing in, which requires
washing his hands with special soaps and putting on sterile garments, including a
gown, gloves and face mask. When the surgeon arrives, the nurse helps her with
her gown and gloves before preparing the patient for surgery.

During Surgery

During the operation, one of the scrub nurses primary duties is selecting and
passing instruments to the surgeon. University of Colorado Health describes the
scrub nurses role as supporting the surgeon while also maintaining patient safety.
The nurse must know which instruments are used for specific procedures and when
they are needed, so she can quickly hand them to the surgeon. The scrub nurse
must also watch for hand signals to know when the surgeon is ready for the next
tool or when he is done using a tool and is ready to hand it back to the scrub nurse,
who cleans the tools after use and places each tool back in its place on the table.
She also monitors the surgery to ensure everything remains sterile.

After Surgery

After the operation, the scrub nurse again counts all instruments, sponges and other
tools and informs the surgeon of the count. He removes tools and equipment from
the operating area, helps apply dressing to the surgical site and transports the
patient to the recovery area. He also completes any necessary documentation
regarding the surgery or the patient's transfer to recovery.

Working Conditions and Challenges

Because scrub nurses are so vital to surgical procedures, they may work long hours,
even for a single operation, and may be called in at all hours to assist in emergency
operations. They must have a thorough knowledge of operating room procedures,
including the tools needed for specific surgeries, and must be able to stay calm and
clearheaded even under pressure. They must also have excellent communication
skills, because one of their primary duties is working with the surgeon and assisting
her with anything she needs during the operation.

What Are the Functions of a Scrub Nurse?

To a layperson, the cluster of gowned figures gathered around an operating table

might be confusing. Yet, each person standing around the patient has a clearly
defined role and serves a vital function. Aside from the surgeon, any given
procedure might also include surgical residents, a surgical assistant, and one or
more perioperative nurses. Perioperative nurses, formerly known as OR nurses, are
trained RNs who specialize in the care of surgical patients. When their duties place
them beside the operating table, they're also called "scrub nurses."

"Scrubbing in" is a term used in surgery for the sterilization procedures used by the
surgical team. This means carefully scrubbing hands and forearms, then donning
the sterile surgical mask, gloves and gown. Team members who are scrubbed in
work directly alongside the patient, in a sterile area. Those working outside this area
are said to be "circulating" and can't approach the patient. One of the scrub nurse's
primary responsibilities is to arrive before the procedure to set up the room,
checking its condition and ensuring that adequate supplies are available. In the
absence of a surgical technician, a scrub nurse will assist other team members with
gowning after they scrub.

Assisting

During surgery, the scrub nurse assists the surgeon by passing instruments -- such
as scalpels and retractors -- or supplies -- such as pads and sponges -- to the
surgeon. This is more demanding than it sounds. The nurse must be knowledgeable
enough to follow the progress of the procedure and anticipate the surgeon's needs,
having the correct items available immediately when requested. The scrub nurse
also maintains a count of pads and sponges used in the procedure, and verifies that
the correct number are also removed from the patient. When necessary, the scrub
nurse requests additional instruments or supplies from the circulating team
members.

Non-Surgical Duties

While the scrub nurse designation is only applicable during an operation,

perioperative nurses have a range of duties outside of the operating room. Before
the procedure, they assess the patient and lay out a nursing plan for pre- and post-
operative care. They'll explain the procedure to the patient and patient's family, and
discuss coping strategies for the recovery period. After the surgery, the scrub nurse
is often responsible for monitoring the patient's condition, alert for any indicators of
a good or bad outcome. Senior perioperative nurses might also spend part of their
time on training, supervisory or administrative duties.

The Career

Registered nurses enter the field with either an associate or bachelor's degree in
nursing. Those who demonstrate an aptitude for surgical nursing can earn the
Certified Nurse Operating Room, or CNOR, credential through the Competency and
Credentialing Institute. A 2011 salary survey by the Association of periOperative
Registered Nurses reported an average salary of $67,800 per year for staff-level
nurses. Directors of nursing in large facilities averaged $127,000 per year. The
Bureau of Labor Statistics projected 26 percent job growth for registered nurses
between 2010 and 2020, with the fastest growth occurring in day-surgery clinics
and similar settings.

Sterilization of Operation Theatres: Newer Methods to Replace Fumigation

In spite of brief stay of patients in the operation theatre, the environment of

operation theatre plays a great role in the onset and spread of infections, because
of multifactor causation of infections. It is usually necessary to study the
epidemiology of infection as a multidisciplinary approach. In resource poor
circumstances as in most developing countries, people work in isolation and few
facilities to make any epidemiological surveys. Many believe that routine
Microbiological monitoring is most essential but in reality it is not practicable. But
every hospital should pay good attention in proper maintenance of air conditioning
plants, ventilator systems, and to have greater control on mechanisms and
personnel involved in disinfection and sterilization of materials used in the theatres
in operative procedures.

Sterilisation means eradicating germs completely, which is not 100% possible in an

operation theatre. The sources of bacterial contamination are from air and the
environment, infected body fluids, patients, articles, equipment etc. The following
methods are practiced to keep the operation theatre (OT) bacteriologically safe and
below accepted levels:

1. Special air flow pattern (the air flow pattern is such that filtered and purified air
circulates and contaminated air is removed continuously). There is restriction of
personnel traffic, closing of OT doors and a good ventilation system.

2. Standard cleaning, disinfection with appropriate chemical agents, good theatre

practice, discipline, can provide a microbiologically safe environment.

Fumigation is an age old process of sterilisation, of the environment, may be a sick

room or operation theatres. It is usually done with formalin fumes, which are are
very pungent and harmful. So when a room is fumigated, it is tightly closed and
sealed before fumigation. The room is opened after fumigation (12 - 24 hours). The
room can be used once all fumes are out.

OSHA indicated that formaldehyde should be handled in the workplace as potential

carcinogen and set an employee exposure standard for formaldehyde that limits an
8-hour time- weighted average exposure concentration of 0.75ppm. Formaldehyde
is the commonly used agent. Formaldehyde gas is generated from liquid formalin
utilizing potassium permanganate crystals. 40% formalin liquid is added to
potassium permanganate crystals to generate gas. Alternately, formalin liquid can
be dispersed by a sprayer like device in the theatre environment. After a contact
time of at least 6-8 hours, the formaldehyde needs to be neutralized by using
ammonia, allowing at least 2 hours contact time for ammonia to neutralize the
formaldehyde prior to the use of theatre.

Fumigation is obsolete in many developed nations in view of toxic nature of

Formalin. Too frequent use and inhalation is hazardous. Several new safe chemicals
are emerging but constrains of economy limit the use and several hours of closure
of operation theatres can be curtailed as with Fumigation.

Aldehydes are potentially carcinogenic and it is therefore recommended that other

agents such as hydrogen peroxide, hydrogen peroxide with silver nitrate, peracitic
acid and other chemical compounds of formaldehyde should be used in place of the
currently prevalent practice of using formaldehyde. These agents are dispersed with
the aid of a fogger-like device inside the theatre environment. The contact time is
about an hour and the theatre can be used immediately after the contact time.

Emerging Compounds in use for Sterilization of Operation theatres:

Bacillocidrasant:

A newer and effective compound in environmental decontamination with very good

cost/benefit ratio, good material compatibility, excellent cleaning properties and
virtually no residues. It has the advantage of being a Formaldehyde-free disinfectant
cleaner with low use concentration.

Advantages

- Provides complete asepsis within 30 to 60 minutes.

- Cleaning with detergent or carbolic acid not required.

- Formalin fumigation not required.

- Shutdown of O.T. for 24 hrs. not required.

Other Newer and Non Toxic compounds:

A Chemical compound - VIRKON is gaining importance as non-Aldehyde compound.

Virkon is proved to be a safe virucidal, bactericidal, fungicidal, mycobactericidal and
non-toxic compound. It contains oxone (potassium peroxymonosulphate), sodium
dodecylbenzenesulfonate, sulphamic acid; and inorganic buffers. It is typically used
for cleaning up hazardous spills, disinfecting surfaces and soaking equipment.
Though Virkon is shown to have wide spectrum of activity against viruses, some
fungi, and bacteria, it however is less effective against spores and fungi than some
alternative disinfectants. Several other compounds are emerging in the Market for
safer use, may need better resources for utility and implementation.

Sterilization

Steam See also: Moist heat sterilization

Front-loading autoclave

A widely used method for heat sterilization is the autoclave, sometimes called a
converter or steam sterilizer. Autoclaves use steam heated to 121-134 C under
pressure. To achieve sterility, the article is heated in a chamber by injected steam
until the article reaches a time and temperature setpoint. Meantime almost all the
air is removed from the chamber, because air is undesired in the moist heat
sterilization process (this is one trait that differ from a typical pressure cooker used
for food cooking). The article is then held at that setpoint for a period of time which
varies depending on the bioburden present on the article being sterilized and its
resistance (D-value) to steam sterilization. A general cycle would be anywhere
between 3 and 15 minutes, (depending on the generated heat)[11] at 121 C at 100
kPa, which is sufficient to provide a sterility assurance level of 104 for a product
with a bioburden of 106 and a D-value of 2.0 minutes.[12] Following sterilization,
liquids in a pressurized autoclave must be cooled slowly to avoid boiling over when
the pressure is released. This may be achieved by gradually depressurizing the
sterilization chamber and allowing liquids to evaporate under a negative pressure,
while cooling the contents.

Proper autoclave treatment will inactivate all resistant bacterial spores in addition to
fungi, bacteria, and viruses, but is not expected to eliminate all prions, which vary in
their resistance. For prion elimination, various recommendations state 121-132 C
for 60 minutes or 134 C for at least 18 minutes.[citation needed] The 263K scrapie
prion is inactivated relatively quickly by such sterilization procedures; however,
other strains of scrapie, and strains of CJD and BSE are more resistant. Using mice
as test animals, one experiment showed that heating BSE positive brain tissue at
134-138 C for 18 minutes resulted in only a 2.5 log decrease in prion infectivity.
[13]
Most autoclaves have meters and charts that record or display information,
particularly temperature and pressure as a function of time. The information is
checked to ensure that the conditions required for sterilization have been met.
Indicator tape is often placed on packages of products prior to autoclaving, and
some packaging incorporates indicators. The indicator changes color when exposed
to steam, providing a visual confirmation.

Biological indicators can also be used to independently confirm autoclave

performance. Simple bioindicator devices are commercially available based on
microbial spores. Most contain spores of the heat resistant microbe Geobacillus
stearothermophilus (formerly Bacillus stearothermophilus), which is extremely
resistant to steam sterilization. Biological indicators may take the form of glass vials
of spores and liquid media, or as spores on strips of paper inside glassine
envelopes. These indicators are placed in locations where it is difficult for steam to
reach to verify that steam is penetrating there.

For autoclaving, cleaning is critical. Extraneous biological matter or grime may

shield organisms from steam penetration. Proper cleaning can be achieved through
physical scrubbing, sonication, ultrasound or pulsed air.[14] Pressure cooking and
canning are analogous to autoclaving, and when performed correctly renders food
sterile.

Moist heat causes destruction of micro-organisms by denaturation of

macromolecules, primarily proteins. This method is a faster process than dry heat
sterilization.

Dry heat[edit] See also: Dry heat sterilization

Dry heat sterilizer

Dry heat was the first method of sterilization, and is a longer process than moist
heat sterilization. The destruction of microorganisms through the use of dry heat is
a gradual phenomenon. With longer exposure to lethal temperatures, the number of
killed microorganisms increases. Forced ventilation of hot air can be used to
increase the rate at which heat is transferred to an organism and reduce the
temperature and amount of time needed to achieve sterility. At higher
temperatures, shorter exposure times are required to kill organisms. This can
reduce heat-induced damage to food products.[15]

The standard setting for a hot air oven is at least two hours at 160 C. A rapid
method heats air to 190 C for 6 minutes for unwrapped objects and 12 minutes for
wrapped objects.[16][17] Dry heat has the advantage that it can be used on
powders and other heat-stable items that are adversely affected by steam (e.g. it
does not cause rusting of steel objects).
Flaming[edit]

Flaming is done to loops and straight-wires in microbiology labs. Leaving the loop in
the flame of a Bunsen burner or alcohol lamp until it glows red ensures that any
infectious agent gets inactivated. This is commonly used for small metal or glass
objects, but not for large objects (see Incineration below). However, during the
initial heating infectious material may be "sprayed" from the wire surface before it
is killed, contaminating nearby surfaces and objects. Therefore, special heaters
have been developed that surround the inoculating loop with a heated cage,
ensuring that such sprayed material does not further contaminate the area. Another
problem is that gas flames may leave carbon or other residues on the object if the
object is not heated enough. A variation on flaming is to dip the object in 70% or
higher ethanol, then briefly touch the object to a Bunsen burner flame. The ethanol
will ignite and burn off rapidly, leaving less residue than a gas flame.

Incineration[edit]

Incineration is a waste treatment process that involves the combustion of organic

substances contained in waste materials. This method also burns any organism to
ash. It is used to sterilize medical and other biohazardous waste before it is
discarded with non-hazardous waste. Bacteria incinerators are mini furnaces used to
incinerate and kill off any micro organisms that may be on an inoculating loop or
wire.[18]

Tyndallization[edit]

Named after John Tyndall, Tyndallization[19] is an obsolete and lengthy process

designed to reduce the level of activity of sporulating bacteria that are left by a
simple boiling water method. The process involves boiling for a period (typically 20
minutes) at atmospheric pressure, cooling, incubating for a day, then repeating the
process a total of three to four times. The incubation periods are to allow heat-
resistant spores surviving the previous boiling period to germinate to form the heat-
sensitive vegetative (growing) stage, which can be killed by the next boiling step.
This is effective because many spores are stimulated to grow by the heat shock. The
procedure only works for media that can support bacterial growth, and will not
sterilize non-nutritive substrates like water. Tyndallization is also ineffective against
prions.

Glass bead sterilizers[edit]

Glass bead sterilizers work by heating glass beads to 250 C. Instruments are then
quickly doused in these glass beads, which heat the object while physically scraping
contaminants off their surface. Glass bead sterilizers were once a common
sterilization method employed in dental offices as well as biologic laboratories,[20]
but are not approved by the U.S. Food and Drug Administration (FDA) and Centers
for Disease Control and Prevention (CDC) to be used as a sterilizers since 1997.[21]
They are still popular in European as well as Israeli dental practices although there
are no current evidence-based guidelines for using this sterilizer.[20]

Chemical sterilization[edit]

Chemiclav

Chemicals are also used for sterilization. Heating provides a reliable way to rid
objects of all transmissible agents, but it is not always appropriate if it will damage
heat-sensitive materials such as biological materials, fiber optics, electronics, and
many plastics. In these situations chemicals, either as gases or in liquid form, can
be used as sterilants. While the use of gas and liquid chemical sterilants avoids the
problem of heat damage, users must ensure that article to be sterilized is
chemically compatible with the sterilant being used. In addition, the use of chemical
sterilants poses new challenges for workplace safety, as the properties that make
chemicals effective sterilants usually make them harmful to humans.

Ethylene oxide[edit]

Ethylene oxide (EO,EtO) gas treatment is one of the common methods used to
sterilize, pasteurize, or disinfect items because of its wide range of material
compatibility. It is also used to process items that are sensitive to processing with
other methods, such as radiation (gamma, electron beam, X-ray), heat (moist or
dry), or other chemicals. Ethylene oxide treatment is the most common sterilization
method, used for approximately 70% of total sterilizations, and for over 50% of all
disposable medical devices.[22]

Ethylene oxide treatment is generally carried out between 30 C and 60 C with

relative humidity above 30% and a gas concentration between 200 and 800 mg/l.
[23] Typically, the process lasts for several hours. Ethylene oxide is highly effective,
as it penetrates all porous materials, and it can penetrate through some plastic
materials and films. Ethylene oxide kills all known microorganisms such as bacteria
(including spores), viruses, and fungi (including yeasts and molds), and is
compatible with almost all materials even when repeatedly applied. It is flammable,
toxic and carcinogenic, however, with a reported potential for some adverse health
effects when not used in compliance with published requirements. Ethylene oxide
sterilizers and processes require biological validation after sterilizer installation,
significant repairs or process changes.

The traditional process consists of a preconditioning phase (in a separate room or

cell), a processing phase (more commonly in a vacuum vessel and sometimes in a
pressure rated vessel), and an aeration phase (in a separate room or cell) to remove
ethylene oxide residues and lower by-products such as ethylene chlorohydrin (EC or
ECH) and, of lesser importance, ethylene glycol (EG). An alternative process, known
as all-in-one processing, also exists for some products whereby all three phases are
performed in the vacuum or pressure rated vessel. This latter option can facilitate
faster overall processing time and residue dissipation.

The most common ethylene oxide processing method is the gas chamber method.
To benefit from economies of scale, ethylene oxide has traditionally been delivered
by filling a large chamber with a combination of gaseous ethylene oxide either as
pure ethylene oxide, or with other gases used as diluents (chlorofluorocarbons
(CFCs), hydrochlorofluorocarbons (HCFCs), or carbon dioxide).

Ethylene oxide is still widely used by medical device manufacturers . Since ethylene
oxide is explosive at concentrations above 3%,[24] ethylene oxide was traditionally
supplied with an inert carrier gas such as a CFC or HCFC. The use of CFCs or HCFCs
as the carrier gas was banned because of concerns of ozone depletion.[25] These
halogenated hydrocarbons are being replaced by systems using 100% ethylene
oxide because of regulations and the high cost of the blends. In hospitals, most
ethylene oxide sterilizers use single use cartridges because of the convenience and
ease of use compared to the former plumbed gas cylinders of ethylene oxide
blends.

It is important to adhere to patient and healthcare personnel government specified

limits of ethylene oxide residues in and/or on processed products, operator
exposure after processing, during storage and handling of ethylene oxide gas
cylinders, and environmental emissions produced when using ethylene oxide.

The U.S. Occupational Safety and Health Administration (OSHA) has set the
permissible exposure limit (PEL) at 1 ppm calculated as an eight-hour time weighted
average (TWA) [29 CFR 1910.1047] and 5 ppm as a 15-minute excursion limit (EL).
The National Institute for Occupational Safety and Health (NIOSH) immediately
dangerous to life and health limit (IDLH) for ethylene oxide is 800 ppm.[26] The
odor threshold is around 500 ppm,[27] so ethylene oxide is imperceptible until
concentrations well above the OSHA PEL. Therefore, OSHA recommends that
continuous gas monitoring systems be used to protect workers using ethylene oxide
for processing.[28] Employees' health records must be maintained during
employment and after termination of employment for 30 years.

Basic Surgical Instruments and their Uses

Scalpel

Surgical Staples

Surgical Suture

Hemostat

Dilator
Scissors

Curette

Forceps

Retractors

Surgical Elevator

Probe

Needle Holder

Information about the most frequently used surgical instruments with their pictures
is given below:

Scalpel

This is a surgical knife that comes with a sharp stainless steel blades. Whether it is
a minor or a major surgery, a correct surgical incision is a must, which is not
possible without a scalpel. Each and every surgery has its own specific needs. For
instance, a minor surgery will require a small incision whereas a major surgery may
demand an incision deep into the skin tissues. So taking this into consideration,
scalpels are manufactured in a variety of sizes. The blades of scalpel are detachable
and many times this instrument is designed for one time use only.

Surgical Staple

Talking about list of surgical instruments and one simply cannot forget to mention
about surgical staples. Normally, an incision made or an open wound that occurs
during surgery cannot be left open as it can trigger internal bleeding. A common
practice is to seal these cuts using stitches but nowadays surgeons prefer to use
surgical staples instead of stitches. The main advantage is that the possibility of
blood leaking from a wound closed by a surgical staple is minimal. Apart from
closing the incision, surgical staples are also useful to reattach and remove portions
of certain organs. For instance, a bowel surgery may demand cutting certain parts
of the intestine and reconnecting the remaining portion of the intestine. This can be
effectively and precisely done using surgical staples.

Surgical Suture

As we all know, during surgery incisions are made to carry out the procedure.
Surgical sutures, which are nothing but stitches, are commonly used to reconnect
the tissues so as to close the incision after the surgical procedure is over. Sutures
also help to join wound edges after an injury. This closing of wound helps to
facilitate healing of the injury. Modern sutures are made from synthetic material that
can be either absorbable or non-absorbable one.
As the name suggests, absorbable sutures are absorbed by the body over a course
of time. The duration of absorption varies according to the type of suture material
but lasts anywhere between 10 days to 2 months. When the suture is placed deep
inside the body or the patient is not in a position to visit the hospital again to
remove sutures, then the absorbable sutures are used. Absorbable sutures are
primarily constructed from synthetic material like polylactic acid, polyglycolic acid,
and caprolactone.

Non-absorbable sutures are non-biodegradable; hence cannot be broken down by

the body and absorbed. The material used in making non-absorbable sutures is
usually polypropylene, nylon, or polyester. Stainless steel wires that exhibit high
tensile strength are often preferred to close the sternum following heart surgery. In
general, Non-absorbable sutures have an advantage over their counterparts, as
they cause minimal scarring. Usually these sutures are removed after a specified
duration but in some cases, they are allowed to remain in position.

Hemostat

During any surgical procedure, some amount of bleeding is a given. A slight incision
here and there is followed by bleeding. In order to prevent any sort of major
complications, the surgeon often uses a hemostat. This is a clamp-like surgical tool
that is utilized to constrict a blood vessel, which helps to minimize or stop the flow
of blood during any surgical procedure.

Dilator

Surgical procedures involving the esophagus, urethra, or the cervix often require the
surgeon to enlarge the opening of these tubular structures. This can be done using
dilators, instruments that expand the passage, thereby allowing the surgeon to
access the organ and perform the surgeon properly. These tools induce dilation to
open up a tube, duct or cavity for surgical purposes.

Scissors

As the name suggests, this surgical instrument is mainly used to cut body tissues.
Scissors used in surgery come in two main types: Mayo and Metzenbaum scissors.
When it comes to cutting or dissecting soft delicate tissues, surgeons prefer the
metzenbaum scissors. The Mayo scissors are used for cutting hard tissues such as
joints. Thick tissues located in the breast and the muscles can also be cut using
Mayo scissors. Usually, these scissors are made up of stainless steel and are
manufactured in variable lengths.

Needle Holder
As we all know, stitching the body tissues that are cut at the time of surgery is a
very important task. Even a slight mistake while sewing the tissue is likely to make
the patient uncomfortable days after completing the surgery. An improperly sewn
skin tissue can be a cause of great pain and may require another surgery to correct
it. To avoid all these complications and to carry out sewing of tissues accurately,
surgeons often make use of needle holders. These instruments allow the surgeon to
hold the needle firmly while stitching the required tissue.

A needle holder that has a shape similar to a scissor, consists of straight, smooth
jaws, joints and handles. It comes with a tungsten carbide inserts that are attached
at the end of both the jaws. They ensure that the needle does not move while
sewing tissues. In simple words, these instruments are designed to provide a strong
grip on the needle, thereby substantially reducing the chances of any error during
this stage of surgery.

Forceps

Forceps are like kitchen tongs that allow the surgeon to grasp and hold the skin
tissues firmly. Whether it is holding a part of intestine or clamping the arteries
during operation, one can always rely on these forceps. Also, this surgical
instrument comes in a range of sizes so that the surgeon can choose one depending
upon his specific needs. Forceps that are designed to hold a baby's head are quite
large and their main purpose is to safely remove the baby from the birth canal
during a cesarean.

Curette

This surgical tool resembling to a spoon is used for taking out unwanted tissue from
internal body cavities. Using the tool, the surgeon simply scrapes to scoop out the
abnormal tissue. Cleaning procedure such as removing cancer growth may require
use of curette.

Retractors

When an incision is made, it has to be kept open during surgery. This job of keeping
the incision wide open is done by retractors. These instruments are used to pull
back the tissues so that the surgeon can easily access the operation site and
perform the surgery without any hindrance. Sometimes even the organs have to be
held back using retractors, so as to expose the surgical site to the desired level.
Retractors are made available in different sizes and shapes. Also, there are different
types of retractors and each one is designed to retract a specific organ. For
instance, lung retractors may be used to push aside the lungs gently for getting an
unobstructed view of the surgical site. So, be it a gallbladder surgery or a breast
reduction surgery, it cannot be done without retractors.

Surgical Elevator
When it comes to performing oral surgery such as tooth extraction, it is not possible
without a surgical elevator. This tool is commonly used in dentistry for removing or
separating affected teeth from their sockets. It is also used for separating bones
from their tissues.

Probe

A probe is a long, flexible surgical tool that has a blunt end and is used for probing a
wound and body cavities such as sinus tract. The instrument helps to evaluate the
wound such as how deep the wound is. The direction of wound can also be assessed
using this tool. As the instrument is inserted in the wound or cavity, excessive
usage can trigger pain and cause pain in patients.