Instrument Tray System

, Paul D. Siney¹ and Patricia A. Fleming¹

(1)

The John Charnley Research Institute Wrightington Hospital, Wigan, Lancashire, UK

The surgical operation is divided into seven convenient stages and the instruments for each stage are kept permanently in separate trays

Tray system, as introduced by Charnley for his operation of hip replacement, or in fact any system which provides a sterile set of instruments and drapes for any invasive procedure, is now a standard practice. It must be appreciated, however, that until the tray system was adopted it was customary to have a collection of instruments laid out for the whole operating session, often lasting several hours! The table was covered with a sterile drape which was lifted as the instruments were taken or added to.

With the instrument tray system in place, the theatre, with its clean air unidirectional downward flow and the total body exhausts, virtually becomes an extension of the autoclave.

The tray system imposes discipline which ensures uninterrupted flow of the well rehearsed operation.

The Seven Tray System for the Charnley LFA

Each of the seven trays contained the instruments essential for the particular stage of the operation, but a number of these had clearly to be retained till a later or even the final stage of the procedure e.g. retractors or skin isolation towel clips.

Tray 1

Skin incision to deep fascia, haemostasis and isolation of cut skin edges with towels (Fig. 7.1)

Tray 2

Incision of deep fascia, initial incision retractor, trochanteric osteotomy using Gigli saw, dislocation of the hip and section of the femoral neck (Fig. 7.2)

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