Identify the instrument shown in the picture below?& x20; - AIIMS Delhi NO - 2018

AIIMS Delhi NO - 2018

Medical Surgical Nursing

Easy

Appeared in: AIIMS Delhi NO - 2018

Explanation

The instrument in the image is a Balfour abdominal retractor, a type of self-retaining retractor.
Its defining features, visible in the picture, are the two large lateral blades and a central, adjustable blade.
This three-blade configuration is designed to retract the abdominal wall laterally and the bladder inferiorly, providing wide, hands-free exposure during major abdominal and pelvic surgeries like laparotomy.
The self-retaining nature of the Balfour retractor reduces the need for surgical assistants to hold retractors, thus minimizing team fatigue during long operations.

Option A: A Doyen's retractor is a handheld instrument with a single, broad, curved blade. The instrument in the image is self-retaining and has multiple blades.
Option C: A Fritsch retractor is a handheld, malleable retractor, typically used to retract soft tissues like the abdominal wall. It is not self-retaining and has a different shape.
Option D: An Omni-Tract retractor is a much more complex, modular, ring-based self-retaining system. It consists of a frame that attaches to the operating table and multiple interchangeable retractor blades, which is structurally different from the simpler frame of the Balfour retractor shown.

Clinical Relevance

Nursing practice connection: This is primarily an exam-oriented knowledge point with limited direct bedside application, so retain Identification of surgical instruments used in abdominal surgery as background academic context rather than a clinical decision trigger.
Recognizing surgical instruments is a fundamental skill for perioperative nurses to ensure the correct equipment is available and to anticipate the surgeon's needs.
The use of self-retaining retractors like the Balfour significantly impacts the surgical workflow by providing stable, consistent exposure of the operative field, which can improve safety and efficiency.
Proper placement of the retractor blades is critical to avoid nerve injury. For example, the lateral blades must be placed carefully to avoid compression of the femoral nerve against the pelvic sidewall.

How to Approach the Question

First, analyze the image to identify the key characteristics of the instrument. Note that it is a large, metallic instrument with a frame.
Identify the primary features: it has a mechanism to hold itself in place (self-retaining) and consists of multiple distinct blades (two on the sides, one in the center).
Next, evaluate the given options based on your knowledge of surgical instruments.
Compare the features you observed with the description of each option. 'Balfour abdominal retractor' is known to be a self-retaining retractor with two lateral blades and a central blade, matching the image perfectly.
Eliminate the other options. Doyen's and Fritsch are handheld. Omni-Tract is a more complex, modular system. This process confirms the correct identification.

Concept Tested & Keywords

Concept Tested: Identification of surgical instruments used in abdominal surgery.
Stem keywords: instrument, picture, identify
Lead-in keywords: Identify

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E6 Gynecology Williams p. 429-437