(About Forceps)
Instrument usage: Forceps are used to grasp tissue atraumatically and hold tissue in place during the surgical procedure while dissecting or suturing.1 There are many different types of forceps with different tips depending upon the type of tissue that is being grasped or held. It is vital that the surrounding tissue is not damaged and not perforated.1 All surgical specialties use forceps.
Key differences:
Forceps can be toothed or smooth depending if it is being used on skin or heavy tissue or deeper on more delicate tissue. A common toothed forcep used on skin is an Adson forcep. A common forcep used in general surgery in the abdomen is a plain forcep.
The forcep can also be straight or angled, also known as bayonet style.1,2 Bayonet style forceps help prevent the surgeon’s hand from occluding the line of vision by offsetting the handle with an angle.1 This is commonly used in small spaces such as nasal or neuro surgery.
Forceps can be short for superficial grasping and holding or long for when in a deep body cavity. A commonly used long forcep that is used in the abdomen is a long plain forcep.
Forceps can have a fine tip for delicate tissue, such as a debakey forcep used in vascular surgery.1
Safety on the sterile field:
It is important when passing a forcep on the sterile field to look at the tip of the forcep and be certain to pass the correct type of forcep so that the tissue is not traumatized by using the incorrect forcep. Also, when working in the body cavity, it is important to determine when a longer forcep is needed to reach the tissue that is being grasped or held.
When passing a suture on a needle holder, a forcep is always passed alongside the suture on the needle holder because both are used together. The forcep will be used to approximate the tissue and assist in pulling the suture needle through the tissue.
It is good practice to pair forceps on the back table and nest them within each other. Always bring the pair of forceps up on the mayo stand. There should never be just one forcep brought up to the mayo stand.
Instrument names:
All forceps can also be called “pick-ups.”1 Smooth forceps can also be called “thumb forceps.” Usually, smooth forceps are used on layers beneath the skin or on delicate tissue. Toothed forceps also called “mouse-tooth forceps” or “rat-tooth forceps” and are used on skin and heavy tissue such as fascia.2 All other forceps are called by their name, such as “Adson”, “DeBakey”, “Gerald,” or simply “forcep”, if the same one is used repeatedly. Sometimes the surgeon will use a hand signal of the thumb taping the pointer finger to indicate the need for a forcep.
References:
1. Phillips, Nancymarie. Berry & Kohn's operating room technique. Elsevier Health Sciences, 2016.
2. Rothrock, Jane C. Alexander's Care of the Patient in Surgery-E-Book. Elsevier Health Sciences, 2018.