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Capsular fragment forceps were designed especially for small-incision microsurgery. The blades were fashioned in a bayonet design so that capsular material may be grasped by the tip of the forceps while iris is not pinched by the heel of the forceps.
Wound care experts have, over recent years, questioned the routine use of forceps and cotton wool balls in packs used for cleansing and dressing wounds. Despite relevant research supporting this view, these items still appear in wound care packs in some hospitals and the basis for this practice, at times, does not seem to have been questioned. A project to explore the effect of introducing a new pack (substituting gloves and non-woven gauze for cotton wool and forceps) was undertaken at St James's University Hospital in the summer of 1993. Nurses' opinions regarding satisfaction with the new pack were explored along with whether they would prefer to use forceps. Results showed that the majority of nurses were satisfied with the new packs and found them an appropriate, acceptable alternative. The Accident and Emergency findings are reported with a discussion of the implications for practice.
BACKGROUND: Endoscopic removal of distally migrated and impacted biliary metallic stents is technically challenging. An open-biopsy-forceps technique for endoscopic removal of these migrated stents is described. METHODS: The technique was used in 4 patients with distally migrated and impacted covered metallic stents. A closed biopsy forceps was advanced through the stent mesh and opened within the stent to form an "anchor." With endoscope withdrawal, the stent was dislodged easily from the duodenum to the stomach. After grasping an end of the stent with a snare, the stent was removed by complete withdrawal of the endoscope. OBSERVATIONS: In all patients, the impacted stent was removed successfully. Mean time for removal was 10.2 minutes. Although ulceration was evident in the duodenal wall where the distal stent end was impacted in all patients, no other complication or adverse event was observed. CONCLUSIONS: The open-biopsy-forceps technique is useful for endoscopic removal of distally migrated and impacted biliary metallic stents.
BACKGROUND: Colonoscopic polypectomy of giant pedunculated polyps has an increased risk of bleeding and is technically difficult. To facilitate the removal of the polyps, we handcrafted a two-channel colonoscope and applied it for grasping-forceps-assisted resection. METHODS: We easily handcrafted a two-channel colonoscope by taping a plastic tube along the shaft of a standard colonoscope and used it for the technique in 10 patients with 12 giant pedunculated polyps. OBSERVATIONS: The colonoscope with forceps assistance proved to be satisfactory for handling detachable and polypectomy snares. Immediate bleeding occurred in one patient because the detachable snare could not be maneuvered over the polyp. In 3 patients, the plastic tube became mobile during the procedure because the tape that attached the tube became loose. No other complications occurred. CONCLUSIONS: A handcrafted two-channel colonoscope for grasping-forceps-assisted resection of giant pedunculated polyps is effective for the prevention of postpolypectomy bleeding and the reduction of technical difficulties.
It has been suggested that a barium enema may safely follow a colorectal biopsy superficial to the muscularis propria within 24 hours, but that the colon radiograph should be postponed 3 to 7 days following a biopsy including this layer. The authors prospectively studied 67 colorectal biopsies obtained with the Wolf 3-mm (grasping) and 5-mm (cutting) proctoscopic forceps from 49 patients to determine the depth of the biopsies. The 5-mm biopsies were not significantly deeper than the 3-mm biopsies (p greater than 0.5). In 18 patients biopsied with each instrument, the 3-mm biopsy was deeper in two cases (11%), the 5-mm biopsy was deeper in three cases (17%), and the biopsies were of equal depth in 13 cases (72%). None of the biopsies with either forceps reached the muscularis propria. The authors concluded that it may be unnecessary to wait longer than 24 hours before performing a barium enema after colorectal biopsy with these forceps.
Hot biopsy forceps technique involves the use of insulated monopolar electrocoagulating forceps to simultaneously biopsy and electrocoagulate tissue. It has been recommended for removal of diminutive polyps and treatment of vascular ectasias of the gastrointestinal tract. The extent of its use and associated complications have not been delineated. This study evaluated the practice of 517 endoscopists. Seventy-one percent (369 endoscopists) used hot biopsy forceps and reported 117 complications, including 85 episodes of bleeding, 19 perforations, and one death. While the overall complication rate was less than that previously reported for colonoscopic polypectomy, 87% of colon perforations occurred on the right side. Factors that may have been important in the development of complications included the degree and length of current application. Adherence to suggested limitations in current application and use of proper technique should result in fewer complications.
This study was designed to determine (1) whether the site of biopsy within the proximal small bowel affects the ability to assess mucosal architecture in general, or to confirm a diagnosis of celiac sprue specifically; and (2) whether endoscopic small bowel biopsy using standard forceps can obtain adequate biopsy specimens to detect or exclude mucosal abnormalities. Three-hundred fifty-two biopsy specimens were obtained prospectively from 26 patients (8 sprue, 2 nonspecific changes, 16 normal) with "jumbo" and standard forceps from jejunum, ligament of Treitz, fourth, third, and second portions of the duodenum. There was no difference in biopsy specimen quality from different locations. All celiac sprue patients had at least one good or excellent specimen from each location, thereby allowing the diagnosis to be made equally well from second, third, and fourth portions of the duodenum, as well as at the ligament of Treitz and jejunum. No false-positive diagnoses of celiac sprue were made. Finally, the standard biopsy forceps provided good or excellent specimens in all patients.
One of the goals of gastrointestinal endoscopy is to diagnose whether a lesion is malignant. The desire to improve the sensitivity of biopsy-sampling techniques prompted us to compare prospectively the reliability and accuracy of obtaining tissue by forceps biopsy, needle biopsy (21 gauge 13-mm long metal needles versus 18 gauge 20-mm long plastic needles), and salvage cytology in patients with endoscopically suspected malignancy. Samples were obtained in the order of needle biopsy (the order of metal and plastic needle biopsy was randomized), forceps biopsy, followed by salvage cytology. Needle biopsies were obtained by puncturing the lesion under direct vision while aspirating with a syringe. Twenty-three patients with gastrointestinal malignancy were studied (7 esophageal, 4 gastric, and 12 colonic). Forceps biopsies were positive in 18 of 23 (78%), missing 1 gastric and 4 colon malignancies. Metal needle biopsy was positive in 16 of 19 (84%), plastic needle biopsy in 17 of 22 (77%), and salvage cytology in 20 of 22 (91%). Accuracy was increased by a combination of techniques. Endoscopic needle biopsy is a simple and rapid method to evaluate lesions seen at endoscopy and is especially useful in evaluation of submucosal lesions.
BACKGROUND: The optimal management of high-grade dysplasia in patients with Barrett's esophagus is controversial. The aim of this study was to assess the prevalence of unsuspected carcinoma at esophagectomy in patients with Barrett's esophagus with high-grade dysplasia after endoscopic surveillance with jumbo biopsy forceps compared with standard biopsy forceps. METHODS: Twelve patients with high-grade dysplasia in Barrett's esophagus without gross or microscopic evidence of carcinoma underwent esophagectomy after preoperative endoscopy with 4-quadrant jumbo biopsies at 2-cm intervals. The findings in this group were compared with those in a group of patients with Barrett's esophagus who underwent esophagectomy for high-grade dysplasia after biopsies obtained at 2-cm intervals with standard biopsy forceps. RESULTS: Unsuspected cancer was found in 4 of 12 (33%) patients in the jumbo biopsy group compared with 6 of 16 (38%) in the standard biopsy group (p = NS). All 6 cancers in the standard biopsy group were intramucosal, whereas 2 were intramucosal and 2 were submucosal in the jumbo biopsy group. No patients in either group had lymph node metastases. CONCLUSIONS: Unsuspected cancer is found frequently in patients with Barrett's esophagus who are undergoing esophagectomy for high-grade dysplasia despite the use of a rigorous jumbo biopsy protocol. Esophageal resection is still indicated in appropriately selected patients with high-grade dysplasia until better markers of cancer risk are available.
We introduce a manual nuclear fragmentation technique, forceps-guided nuclear cleavage. A 5.5 to 7.0 mm superior scleral incision is started 1.5 mm posterior to the limbus. Two additional 1.0 mm paracenteses are made at 3 and 9 o'clock in clear cornea close to the limbus. A continuous curvilinear capsulorhexis (CCC) is created; in most cases, 4 to 5 radial relaxing incisions are made in the CCC. The anterior and equatorial cortex and epinucleus are removed with 2-handed irrigation/aspiration via the 2 paracenteses with the nucleus in the capsular bag. The nucleus is prolapsed into the anterior chamber. A nucleus hook is inserted via the 3 o'clock paracentesis and applied to the 6 o'clock nuclear equator to hold the nucleus. A nucleus cleaving forceps is inserted through the upper incision to the 12 o'clock equator of the nucleus and advanced to one-third depth of the nucleus. The forceps is relaxed while the nucleus is cleaved in half.
PURPOSE: To compare the rate of anterior chamber (AC) contamination during implantation of a foldable three-piece silicone lens using a forceps and an injector. SETTING: Department of Ophthalmology, University of Saarland, Homburg (Saar), Germany. METHODS: In a prospective, randomized study, we cultured AC aspirates of patients who had phacoemulsification with silicone lens implantation through a 3.5 mm temporal clear corneal incision. In Group A, the lens was implanted with a forceps and in Group B, with an injector. Immediately after lens implantation, the AC aspirate (0.05 to 0.10 ml) was collected and sent to the microbiology department. All cultures were incubated for 3 days. As a topical antibiotic, gentamicin was given preoperatively and intraoperatively. RESULTS: One hundred patients (50 in each group) were examined. In each group the bacterial contamination of the AC was 2%. CONCLUSION: Bacterial contamination of the AC was not significantly different after silicone lens implantation with a forceps and with an injector.
Metal implantation forceps can damage the surface of poly(methyl methacrylate) and heparin-surface-modified intraocular lenses (IOLs) during insertion. A new implantation forceps with silicone sleeves covering the tips has been successfully used during IOL implantation. Scanning electron microscopic studies showed that the silicone sleeves prevent forceps-induced IOL surface defects.
Eighty-one patients underwent directed biopsy with a large Lin's biopsy forceps during flexible hysteroscopy performed without cervical dilatation or anesthesia. Ninety-seven specimens were obtained, with an average size of 74.5 3(. For control study, 18 women underwent directed biopsy with a small conventional biopsy forceps. Nineteen specimens were obtained, with average size 3.4 mm3( (p <0.05). In eight women, lost intrauterine devices were retrieved with a large Lin's grasping forceps, which can easily grasp the device directly and remove it during flexible hysteroscopy.
The extraction of impacted foreign bodies from the oesophagus is frequently performed using forceps under endoscopic guidance. We report the case of a 23-year-old prisoner who ingested a lump of cannabis resin which could not be removed from the upper oesophagus with forceps alone. We recommend the use of a Fogarty balloon catheter in conjunction with toothed forceps in such cases.
OBJECTIVES: To evaluate and to compare the safety and efficacy of ureteroscopic lithotripsy methods and forceps use for distal ureteral stones. MATERIALS AND METHODS: 514 patients were evaluated retrospectively who were treated by dye laser, electrohydraulic or ultrasonic lithotripsy or direct forceps extraction for distal ureteral stones between May 1992-October 1999. RESULTS: Laser lithotripsy was determined to be the most effective method with 86.9% success, while ultrasonic lithotripsy was the least effective method with 77.3% success rate. For smaller stones forceps extraction had a 88.5% success rate. CONCLUSION: Ureteroscopic lithotripsy methods are all alternative choice of treatment methods in distal ureteral stones. To our experience, laser lithotripsy is the most effective method of all intracorporeal lithotripsy methods as far as the success and complication rates are concerned.
BACKGROUND: It has been proposed that adenomas of the papilla of Vater are precursors of adenocarcinomas. Duodenoscopy with ERCP and forceps biopsies have substantially improved the morphologic exploration of the major duodenal papilla. Yet there is little and contradictory information as to the diagnostic accuracy of endoscopic biopsies in tumors of the papilla. Moreover, after endoscopic sphincterotomy data on the diagnostic impact of endoscopic biopsies from the papilla are scarce and, in most cases, retrospectively obtained. Thus, the aim of the present prospective and histopathologically controlled study was to assess the diagnostic accuracy of endoscopic biopsies taken from tumors of the papilla before and after sphincterotomy. PATIENTS AND METHODS: Forty patients with tumors of the papilla of Vater were included in the study. In each case, a comparison was made between endoscopic forceps biopsy diagnoses prior to and following sphincterotomy and the definitive histological diagnosis after surgical tumor resection. RESULTS: Resected tumors were diagnosed histomorphologically as follows: 19 adenocarcinomas (47%), 6 tubular adenomas (15%), 7 villous adenomas (17%), 7 inflammatory non-neoplastic lesions (pseudotumors) (17%), and one adenomyoma (2%). Overall accuracy for preoperative histopathological diagnosis was 62% (25 of 40, 95% CI: 47%-76%) prior to sphincterotomy while it was 70% (28 of 40, 95% CI: 55%-81%) following the procedure. Regarding adenocarcinomas, sensitivity was found to be 21% (4 of 19, 95% CI: 8%-43%) prior to and 37% (7 of 19, 95% CI: 19%-58%) after sphincterotomy while specificity was 100% at both times. CONCLUSIONS: Endoscopic forceps biopsies do not allow for reliable preoperative diagnosis of tumors of the papilla of Vater.
BACKGROUND: Cryosurgery is one of the most common treatment methods in the dermatologists armamentarium. We describe a method combining forceps and a cotton applicator to freeze benign lesions for practitioners who prefer to use cotton-tipped applicators instead of a cryosurgery spray device. METHODS: We describe the technique using common in-office instruments. CONCLUSION: Lesions around delicate areas can be treated with forceps and a cotton-tipped applicator dipped in liquid nitrogen resulting in less pain and decreased collateral damage vs. traditional methods. For the most delicate areas, the forceps dipped directly in liquid nitrogen method is preferred.
OBJECTIVE: To report the results of acetabular fracture fixation in 25 dogs in which a specialized forceps (ASIF mandibular reduction forceps, Synthes USA, Paoli, PA) was used to obtain fracture reduction and stabilization. STUDY DESIGN: A retrospective clinical study. ANIMAL POPULATION: Twenty-five client-owned dogs with traumatic acetabular fractures. METHODS: The mandibular reduction forceps (MRF) use a screw on each side of the fracture to attach the clamp directly to the bone and permit direct manipulation of the fragments. Medical records from 25 dogs with acetabular fractures were reviewed to determine the effectiveness of this technique in obtaining, and then maintaining, fracture reduction while a plate was being applied. RESULTS: Clinical results were considered successful in 24 of 25 dogs; the small size of 1 dog prevented application of the MRF. The final reduction and fixation of the fractures was evaluated as anatomic in 17 dogs, near-anatomic in 6 dogs, and nonanatomic in 1 dog. CONCLUSIONS AND CLINICAL RELEVANCE: Application of the MRF is an effective technique for aiding the reduction of acetabular fractures in dogs. It maintains reduction while simultaneously permitting unimpeded access to the dorsal acetabular rim, thus facilitating accurate contouring of a plate. Accurate reduction and rigid fixation of articular fractures is essential to prevent secondary osteoarthritis.