Grasping, Holding, and Tissue Forceps

Objective. Students will differentiate thumb forceps types (tissue, dressing, bayonet, Adson) and ring-handled graspers (Babcock, Allis, sponge forceps) by jaw design, stating the appropriate tissue type and risk of injury for each.

Forceps are among the most frequently handled instruments in the sterile field. Selecting the correct forceps for each tissue type is a core surgical technologist responsibility. The wrong choice can crush delicate structures, tear friable tissue, or fail to hold slippery viscera securely. Understanding jaw design is the key to making safe, appropriate selections.

Thumb Forceps: How They Work

Thumb forceps (also called tissue or dressing forceps) are spring-loaded, non-ratcheted instruments held between the thumb and fingers like a writing instrument. The surgeon or scrub tech squeezes them to close the jaws and releases to open. Because there is no locking mechanism, the user must maintain constant, controlled pressure—neither too light nor too heavy. Excessive force is a common cause of tissue damage.

Dressing (Plain) Forceps

Plain dressing forceps have smooth, flat serrated jaws without teeth. They grip by friction rather than by penetrating tissue. They are used to handle gauze, dressings, and packing material, and to pick up non-delicate tissue that would be damaged by teeth. Because they rely on friction, they can slip on wet or slippery tissue and are not appropriate for holding bowel or vascular structures.

Adson Forceps

Adson forceps are small, lightweight, and designed for delicate work. They come in two versions: with teeth (1×2 teeth) and without teeth (smooth serrations). The toothed version grips skin and fascia firmly with minimal crush force—the tooth does the holding so the surgeon does not need to squeeze hard. The plain Adson is used for finer tissue that cannot tolerate teeth. Toothed Adsons must never be used on blood vessels, nerves, or bowel because the tooth will puncture or tear the structure.

DeBakey Forceps

DeBakey vascular forceps have a distinctive longitudinal double-row serration pattern on the jaw. This design grips tissue firmly without a tooth that could lacerate, making them the standard choice for handling blood vessels, aortic tissue, and other delicate cardiovascular structures. Their length and jaw design allow precise control in deep fields. They are the workhorse of vascular and cardiac surgery but are also widely used in general surgery wherever atraumatic handling is needed.

Russian Forceps

Russian forceps have a round, cup-shaped serrated jaw. The broad contact surface distributes grip across a larger area, reducing point pressure. They are used for grasping peritoneum, fascia, and larger tissue bites during closure. Their rounded tip is less precise than Adsons but offers a secure hold on bulkier tissue. They are not appropriate for vascular work because the serrations can still injure vessel walls.

Bonney Forceps

Bonney forceps are heavy-duty tissue forceps with large teeth designed to grip dense, tough tissue such as abdominal fascia during closure. Their robust construction means they would crush or tear delicate structures and must be limited to heavy fascia and similar tissues.

Bayonet Forceps

Bayonet forceps have an offset (angled) shaft that keeps the surgeon's hand out of the line of sight in deep or narrow surgical fields, most commonly neurosurgical and ear, nose, and throat procedures. The jaw design varies (smooth or with teeth) depending on intended use. Their primary advantage is visibility and access, not a unique grip characteristic.

Ring-Handled Graspers

Ring-handled graspers are hinged instruments with ratcheted locking mechanisms. They maintain their grip without sustained hand pressure, making them suitable for retracting and holding tissue over time.

Babcock Clamp

The Babcock is a fenestrated (windowed), atraumatic clamp with smooth, curved jaws that encircle rather than crush tissue. It is the instrument of choice for grasping the fallopian tube, appendix, small bowel, and other hollow or delicate structures. Because there are no teeth and the jaw distributes pressure around the tissue, it is far less likely to cause serosal tears than toothed instruments. Despite its gentle design, excessive ratcheting force can still injure bowel serosa.

Allis Clamp

The Allis clamp has interlocking fine teeth along its jaw edges. It provides a secure grip on tissue that can tolerate some trauma—typically fascia, dense fibrous tissue, or specimens being removed. It must not be used on bowel serosa, blood vessels, or any structure that must remain intact and undamaged after the case, because the teeth will leave visible injury marks.

Sponge Forceps (Ring Forceps)

Sponge forceps are large ring-handled instruments with smooth or serrated oval jaws. They hold folded radiopaque sponges for skin preparation and wound care, pass sponges into the wound for blotting, and can hold tissue in a pinch. Their primary role is sponge management. Every sponge placed into or removed from the field must be accounted for in the sponge count.

Safety Principles

Always inspect forceps before use: bent tips, misaligned jaws, or broken teeth compromise both function and sterility. Pass forceps with jaws closed and tips pointing downward to prevent injury. Never use a vascular forceps (DeBakey) as a substitute for a hemostat—it is not designed to occlude vessels. Match the forceps to the tissue every time; when in doubt, choose the less traumatic option and ask the surgeon. Tissue damage caused by instrument misuse can result in delayed healing, bleeding, anastomotic leak, or permanent injury to the patient.

Key terms8

AtraumaticDescribes an instrument jaw design that minimizes crushing or tearing injury to delicate tissue, such as the smooth longitudinal serrations of DeBakey forceps or the fenestrated jaws of a Babcock clamp.

Fenestrated jawA jaw with an open window or slot that allows tissue to be encircled and held with distributed pressure rather than pinched between solid blades, as seen in the Babcock clamp.

SerrationFine parallel ridges or grooves machined into forceps jaws to increase friction grip without the penetrating action of a tooth.

RatchetThe locking mechanism on ring-handled instruments that holds the jaws at a set opening without continuous hand pressure; identified by the clicks along the box-lock shank.

Thumb forcepsSpring-loaded, non-ratcheted forceps held between the thumb and fingers; closed by squeezing and opened by releasing pressure.

Bayonet configurationAn offset shaft design that angles the instrument so the surgeon's hand is displaced laterally from the instrument tip, improving visibility and access in deep or narrow operative fields.

SerosaThe outermost smooth layer of bowel and other visceral organs; easily torn by toothed instruments, making atraumatic forceps essential when handling bowel.

Box lockThe hinged joint connecting the two halves of a ring-handled instrument; the area most prone to wear and misalignment and must be inspected before each use.

In class: Side-by-side comparison demonstration: instructor places Adson with teeth, plain dressing forceps, DeBakey forceps, and Russian forceps on a draped surface and explains jaw design differences and tissue trauma implications; students take structured notes. · Simulated tissue exercise: students use each forceps type on soft foam blocks and latex tubing to feel the grip difference and document observations in a lab notebook. · Case-based decision activity: students read five surgical scenarios, select the appropriate forceps, and write a one-sentence rationale; pairs peer-review each other's answers using a provided answer guide.
Materials: Adson tissue forceps (with and without teeth), plain dressing forceps, DeBakey vascular forceps, Russian forceps, Bonney forceps, Babcock clamps, foam practice blocks, latex tubing, lab notebooks, Tighe textbook
Check: Instructor-led oral quiz at the end of the session: student correctly identifies six forceps types and states appropriate tissue application and contraindication for three of them. Pass mark: 80% accuracy across all responses.

Practice check8

Answer each question, then check it. Nothing is recorded; this is your own practice.