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PubMedDate not supplied

A system of multiple biopsy forceps.

AIM: A new system of flexible endoscopic biopsy forceps is described. These forceps are simple, cheap to produce, and disposable. DESIGN: These forceps take larger and less traumatized biopsies than do existing single biopsy forceps. The principle involves that of a central wire with a barbed spike at one end, to which sliding sprung steel jaws are attached. An outer plastic sleeve surrounds the central wire, and conventional-type handles activate the jaws. FUNCTION: The device is passed along the biopsy channel of a fiberoptic endoscope, and the tissue to undergo biopsy is visualized. Opening and closing of the forceps occurs when the outer sleeve slides on the inner wire allowing the sprung steel jaws to open and close. With the jaws open, the barb is pushed into the tissue to undergo biopsy. The fishhook-like barb pulls back the tissue into the jaws, which bite the tissue at an optimal angle and can thus obtain cleaner and bigger biopsies. For the second biopsy, the jaws are simply reopened, and as the barbed spike again pierces the tissue, the first specimen is pushed along the central wire. Up to 6 biopsies are to be stored in this way, in a predictable order, with a single passage of the biopsy forceps through the endoscope.

Biopsy↗

PubMed1997

Damage of foldable intraocular lenses by incorrect folder forceps.

PURPOSE: To evaluate possible damage of foldable silicone or acrylic intraocular lenses caused by the use of incorrect lens folder forceps. METHODS: Ten silicone and 10 acrylic intraocular lenses were divided into two groups, each containing five silicone and five acrylic lenses. Two easily mistaken folder forceps, each expressly designed for either silicone or acrylic lenses only were properly used to fold the intraocular lenses in group 1 whereas in group 2, the silicone lenses were folded with the forceps designed for the acrylic lenses, and the acrylic lenses were folded with the forceps designed for the silicone lenses. We observed the lenses by transmission and scanning microscopy after folding. RESULT: The acrylic lenses folded with forceps designed for the silicone lenses (group 2) disclosed considerable damage of the lens optic. CONCLUSION: Incorrect folder forceps may damage acrylic intraocular lenses.

Acrylates↗

PubMed1995

Surgical techniques for repositioning a dislocated intraocular lens, repair of iridodialysis, and secondary intraocular lens implantation using innovative 25-gauge forceps.

PURPOSE: We developed surgical techniques for the sulcus fixation of a posteriorly dislocated or secondarily implanted posterior chamber intraocular lens, repair of an iridodialysis, and the management of a decentered intraocular lens during vitreous surgery using innovative 25-gauge forceps. METHODS: The 25-gauge forceps have a curved shaft, a tip with a distal platform for grasping a suture, and a proximal groove for gripping a haptic. The forceps are inserted through a grooved scleral incision into the plane of the ciliary sulcus, facilitating manipulations such as fastening a suture loop around a haptic, repositing an intraocular lens at the ciliary sulcus, and grasping sutures during repair of a iridodialysis or implantation of a secondary intraocular lens. Seven patients underwent vitreous surgery using the new forceps. RESULTS: In all seven patients the surgical objectives were accomplished with the 25-gauge forceps without postoperative complications such as hemorrhage, hypotony, or lens decentration. CONCLUSIONS: The 25-gauge forceps are innovative instrumentation designed specifically for anterior segment applications during vitreous surgery.

Adolescent↗

PubMed1998

Occult anal sphincter trauma following randomized forceps and vacuum delivery.

OBJECTIVE: To determine the prevalence of occult anal sphincter trauma 5 years after randomization to forceps and vacuum delivery. METHOD: Anal endosonography and manometry was performed in 44 of 313 women who had originally participated in one center of the Keele University Multicenter Assisted Delivery Trial at the North Staffordshire Maternity Hospital between September 1989 and May 1990. RESULTS: 50% admitted to defecatory symptoms and anal sphincter defects were identified in 61%. On the basis of intention to treat, 82% of forceps (n = 17) and 48% of vacuum deliveries (n = 27) had occult sphincter defects (P = 0.03). In four women, both instruments were used. However, the preponderance of defects in the forceps group persisted even when analysis was performed according to the final mode of delivery as well as in the group where only one instrument was used (n = 40). There was a significant fall in maximum squeeze anal pressure in the forceps group compared to the vacuum group (56 vs. 36 mmHg; P = 0.0007). Although twice as many in the forceps group suffered anal incontinence (32% vs. 16%) significance was not reached. CONCLUSIONS: Vacuum delivery appears to be associated with less occult anal sphincter trauma than forceps delivery. A large prospective randomized study is required to address the impact of specific situations, such as failed instrumentation with use of a second instrument and rotational delivery.

Adult↗

PubMed1980

Comparison of standard and large forceps for transbronchial lung biopsy in the diagnosis of lung infiltrates.

In order to determine whether larger biopsy forceps improve the diagnostic yield over smaller standard forceps, we performed 30 transbronchial biopsy procedures in 28 patients with lung infiltrates using three types of instruments. We found that compared to the standard forceps specimens the large forceps acquired larger specimens in 22 of 29 procedures and that the alligator forceps acquired larger specimens in 7 of 10 procedures. However, in only 2 of the 29 procedures did the larger biopsy specimen alter the pathologic diagnosis. Four of the patients subsequently underwent open lung biopsy which did not alter the pathologic diagnosis rom the transbronchial biopsy procedure. We conclude that the large forceps do not significantly improve the diagnostic yield of transbronchial biopsy in our patients.

Biopsy↗

PubMed1999

The role of forceps in modern obstetrics.

The objective of this study was to assess the safety and devise criteria to minimise complications following forceps deliveries. A prospective analytical study was performed on 644 consecutive forceps deliveries in a Sri Lankan provincial hospital. The incidence of maternal and fetal complications was analysed. The incidence of both cervical and third degree perineal tears was commoner in face-to-pubis deliveries. When the number of traction efforts required to complete the delivery is more than three the incidence of third degree perineal tears and postpartum haemorrhage became significantly commoner. There were six cases of ruptured uterus and all were in multiparous patients following mid-cavity forceps deliveries. The maternal and fetal morbidity following rotational forceps deliveries was no different from non-rotational forceps deliveries. In addition to the standard criteria of head being fully engaged in the pelvis, cervix being fully dilated, the station of the head below the level of the ischeal spines and bladder being empty before attempting forceps delivery, we also recommend that the baby should be delivered occipito-anterior and the number of traction efforts used to be kept at three or less to minimise the maternal trauma.

Journal Article↗

PubMed2003

Use of bipolar laparoscopic forceps to occlude and transect the retroperitoneal vasculature: a porcine model.

BACKGROUND AND PURPOSE: Surgical clips are commonly employed during laparoscopic radical nephrectomy to ligate perihilar vessels reliably, yet these clips can interfere with the application of a vascular stapler to major vessels, potentially leading to catastrophic hemorrhage. We assessed the efficacy of the PlasmaKinetic trade mark (PK) bipolar cutting forceps (Gyrus Medical, Minneapolis, MN) as a single modality in coagulating and dividing the retroperitoneal vessels in a swine model. MATERIALS AND METHODS: Three 40- to 50-kg domestic swine (six renal units) underwent celiotomy and retroperitoneal exposure. The inferior vena cava (IVC) and the renal, gonadal, and iliac vessels were isolated, and, using 5- and 10-mm forceps, coagulated and divided. The mean diameter of the renal vein was 8.7 mm, the renal artery 6.5 mm, and the IVC 14 mm. RESULTS: Hemostasis was achieved consistently using the 5-mm and 10-mm PK Cutting Forceps on the renal artery, renal vein, and gonadal vein. The 10-mm forceps coagulated the iliac veins and IVC 83% of the time with only a single application. Larger vessels or vessels with higher inherent vascular pressure required additional applications of the device to achieve hemostasis. All animals were hemodynamically stable through division of the IVC, as measured by heart rate and pulse oximetry. No complications were noted with the device or using the cutting element. CONCLUSIONS: The PK bipolar cutting forceps appear to be effective in controlling and dividing the renal hilar vessels and larger low-pressure vessels of the porcine retroperitoneum, with no gross damage to adjacent structures. Although further studies are necessary before use during laparoscopic nephrectomy in humans, these results are promising. Bipolar cutting forceps may prove to be a safe, cost-effective, and time-saving device with numerous applications during urologic laparoscopy.

Animals↗

PubMed2000

Bipolar coagulation with small diameter forceps in animal models for in-utero cord obliteration.

The objective of this study was to evaluate the feasibility, efficacy and safety of bipolar coagulation using endoscopic forceps of diameters of 2.7 mm and less in animal models mimicking in-utero conditions. Forceps of 2.2, 2.3, 2.5 and 2.7 mm were tested in rabbits (n = 36). Vessel pairs were dissected and coagulated in a fluid environment under endoscopic vision at 15 and 25 W. The main outcome measure was the perforation rate. In fetal lambs (n = 25), umbilical cords were coagulated under sono-endoscopic control with power settings from 10 to 35 W. Main outcome measures were the duration of coagulation, perforation rate, change in the temperature of the amniotic fluid and efficacy of vessel occlusion rate. At 20-25 W, all cords were coagulated successfully without any perforation using 2.3, 2.5 or 2.7 mm forceps. Coagulation with the 2. 2 mm forceps was associated with a high perforation rate, although the design rather than the diameter of the forceps may have influenced this outcome. Bipolar coagulation with forceps between 2. 3 and 2.7 mm and appropriate power settings achieves efficacious and safe coagulation in animal models for umbilical cord occlusion.

Animals↗

PubMed1976

The relation between ease of forceps delivery and speed of cervical dilatation.

An attempt has been made to predict a difficult forceps delivery. The duration of the 7 to 10 cm cervical dilatation interval was measured from the completed cervimetric chart in 952 consecutive patients who delivered spontaneously between December 1973 and September 1974. The 7 to 10 cm cervical dilatation intervals of this group were compared with those of 378 consecutive patients in whom forceps were applied with the fetal head in the occipito-anterior position and 83 consecutive patients where Kielland's forceps rotation from the occipito-tranverse or occipito-posterior position was performed. The forceps deliveries were graded as 'easy', 'moderately difficult', or 'difficult'. In only 5% of the spontaneous delivery group did the 7 to 10 cm cervical dilatation interval exceed two hours. In the occipito-anterior and Kielland's forceps groups an 'easy' delivery could be expected if the 7 to 10 cm cervical dilatation interval was less than two hours. The greater this interval increased beyond two hours, the greater was the proportion of 'moderately difficult' and 'difficult' forceps deliveries.

Analgesia↗

PubMed2006

Combination forceps fuse both safety and efficiency.

BACKGROUND: Instrumentation prevents needle stick injury. OBJECTIVE: To review forceps that insure safety and facilitate tissue-handling and knot-tying efficiency. METHOD: Medical literature reports were reviewed using Ovid. Commercially available instruments were qualitatively tested. RESULTS: Suture platforms securely hold suture needles and can be used during knot tying. A wide range of combination forceps have been invented and can be broadly categorized as either skin hook or toothed combination forceps. CONCLUSIONS: Combination forceps fuse both efficiency and safety. Skin hook forceps may eventually be the optimal combination instrument, but toothed combination forceps are recommended.

Equipment Design↗

PubMed1998

Biopsy forceps disinfection technique does not influence Helicobacter pylori culture.

OBJECTIVES: Culturing Helicobacter pylori (Hp) has a low sensitivity rate, and is affected by factors such as the number of biopsies, transport, and culture conditions. Hp detection is also influenced by omeprazole, antibiotics, bismuth salts, or benzocaine use. Disinfection procedures based on glutaraldehyde are highly effective in eliminating any Hp contamination of endoscopic equipment. However, the possibility that some residual glutaraldehyde present in biopsy forceps after decontamination could affect Hp viability has not yet been investigated. METHODS: Antral specimens from 25 patients with active gastric or duodenal ulcer obtained with three forceps (sterilized with ethylene oxide, glutaraldehyde, or glutaraldehyde-phenolate) were streaked on appropriate media, and results of culture evaluated. RESULTS: Helicobacter pylori was isolated in 17 patients. Positivity of culture was independent of the way the forceps were sterilized, and the number of colonies (mean +/- SD) was similar for the three types of forceps (475 +/- 312, 533 +/- 242, and 550 +/- 225 colony-forming units [CFUs] for ethylene oxide, glutaraldehyde, and glutaraldehyde-phenolate, respectively). Moreover, the incubation time since isolation was also similar (6.0 +/- 1.3, 5.8 +/- 1.2, and 5.7 +/- 1.2 days for ethylene oxide, glutaraldehyde, and glutaraldehyde-phenolate disinfected forceps, respectively). CONCLUSION: The use of glutaraldehyde to sterilize biopsy forceps is not responsible for the false-negative results of Hp culture.

Biopsy↗

PubMed2003

Development of a flow cytometric method to determine DNA ploidy of oesophageal cancer cells obtained by forceps biopsy samples during oesophago-gastro-duodenoscopy.

BACKGROUND: The DNA content of oesophageal tumour cells is a prognostic factor in untreated patients. To investigate whether DNA ploidy is useful to select patients for neoadjuvant therapy it is of interest to develop a method allowing reliable flow cytometric analysis of the DNA content of tumour cells obtained by forceps biopsy during endoscopy before start of therapy. METHODS: Freshly frozen forceps biopsy samples from 30 patients with oesophageal cancer were disaggregated. DNA was stained with propidium iodide and ploidy was determined by flow cytometry. To enhance sensitivity epithelial cells were simultaneously labelled with anti-cytokeratin antibodies. Results were compared with image analysis. To evaluate the sampling error, parallel measurements were done in 10 patients by image analysis on forceps biopsies obtained during endoscopy before surgery and on the resected tumour. RESULTS: The sensitivity to detect aneuploidy was lower for standard flow cytometry than for image analysis (13 versus 33%). The overall sensitivities were identical using a double labelling technique with additional cytokeratin-staining of the epithelial cells, but divergent results were obtained in 2 cases, where detection of aneuploidy was either possible with image analysis or with double labelling flow cytometry only. DNA content of samples gained by forceps biopsies and surgically resected tumours was concordant in 8 of 10 cases. In 2 patients, aneuploidy was detected only in the surgically resected tumour but not in the pre-operatively obtained forceps biopsies. CONCLUSIONS: A flow cytometric method for routine determination of the DNA ploidy of cells obtained by forceps biopsies from patients with oesophageal cancer was developed and evaluated against image analysis. The technique allows the prediction of DNA content before tumour resection, and might be used for optimising therapy and the patient's quality of live.

Adenocarcinoma↗

PubMedDate not supplied

Status evaluation: hot biopsy forceps. American Society for Gastrointestinal Endoscopy. Technology Assessment Committee.

Monopolar hot biopsy forceps were developed for simultaneous tissue biopsy and electrocoagulation. Many endoscopists used these forceps for coagulation of diminutive polyps of the colon. The rationale for diminutive polyp eradication is to destroy neoplastic tissue and possibly prevent colon cancer. However, convincing data to document a reduction in the incidence of colorectal cancer or even complete obliteration of all treated diminutive polyps with hot biopsy forceps are lacking. Complications of hot biopsy include hemorrhage, perforation, and post-coagulation syndrome. Tissue injury is deeper with monopolar hot biopsy forceps than bipolar forceps. The right colon is particularly susceptible to transmural injury and perforation. For small polyp obliteration, comparative studies of hot biopsy (monopolar and bipolar) with other techniques such as cold biopsy combined with thermal probes, large cup cold biopsy removal, and snare electrocoagulation are warranted. The necessity to biopsy typical appearing angiomata does not seem warranted on a routine clinical basis. The expected obliteration rates of small angiomata or rates of controlling lower gastrointestinal bleeding from colon angiomata after monopolar hot biopsy electrocoagulation have not been well documented. Heater probe or bipolar electrocoagulation have been safely and effectively applied to bleeding colon angiomata. These newer coagulation probes are recommended as an alternative to hot biopsy forceps for treatment of bleeding colonic angiomata.

Biopsy↗

PubMed2004

External Dacryocystorhinostomy: outcomes after the introduction of two new forceps and transnasal endoscopy.

BACKGROUND: There are few lacrimal surgeons in the field of clinical Ophthalmology, while the number of patients with an obstruction of tear duct increases. The success rate for the external dacryocystorhinostomy (DCR) procedure is approximately 90%. The outcome of external DCR using two new forceps and postoperative transnasal endoscopy was studied. MATERIAL/METHODS: 93 consecutive patients (100 cases) underwent external DCR. Two new forceps (a DCR slide forceps and a cleaning forceps in the nasal cavity) were used, and transnasal endoscopic examination postoperatively was done. The relatively small cutaneous incision (12-15 mm) was done. Two new forceps were used during and after the DCR procedure. RESULTS: All the cases showed round or oval ostia and patency on irrigation. Some amount of discharge adherent to the STs was observed in each case within one week after the external DCR procedure. CONCLUSIONS: The transnasal endoscopic examination performed postoperatively and the use of the two new forceps were of value for increasing the success rate of external DCR.

Adult↗

PubMed1992

[The modified Magill forceps].

The Magill forceps are used for nasotracheal intubation, endotracheal suctioning, passing gastric tubes, placement of tampons in the nasopharynx and extraction of foreign material from the pharynx. There are several disadvantages of the standard Magill forceps; however: the danger of cuff perforation, the necessity of readjusting the forceps when placing a tube or catheter, and the risk of injury to the mucous membrane. For these reasons the standard Magill forceps have been modified: the jaws of the forceps have been changed to give curved atraumatic parts without any serrations or sharp edges. RESULTS. The resulting benefits are as follows: Reduced risk of injuring the mucous membrane and perforating the cuff. Tubes and catheter are safely guided between the semiround jaws, making it unnecessary to open the forceps repeatedly to advance the tube. Tampons being placed in the throat no longer get caught between the serrations, and even small foreign objects can easily be extracted from the pharynx.

Anesthesiology↗

PubMed2005

The 23 gauge capsulorrhexis forceps having a cystotome function.

We evaluate the operational performance of the 23 gauge capsulorrhexis forceps with a cystotome function. The 23 gauge capsulorrhexis forceps were applied in 6 complex cases such as cataract surgery after closed-angle glaucoma with shallow anterior chamber, mal mydriasis, or lens subluxation. In all cases, we measured each patient's gonio angle level and degree of mydriasis. The forceps can be used in all cases even shallow anterior chamber glaucoma, because the forceps have both the functions of forceps and a cystotome with 55 degrees angulated needle. Although lens subluxation was found in 5 out of the 6 cases during continuous curvi-linear capsulorrhexis (CCC), implantation of the intraocular lens (IOL) in the capsular bag was successfully completed in these 5 cases. The 23 gauge forceps were effective particularly in cases for cataract surgery after glaucoma operation.

Aged↗

PubMed2006

Long term effects of cutting forceps in endoscopic sinus surgery.

BACKGROUND: At present, some authors prefer cutting forceps to conventional non-cutting forceps in Endoscopic Sinus Surgery, based on the assumption of superior wound healing due to mucosal preservation, without any proof of better clinical outcome. The purpose of this study was to elaborate our previously reported short-term results, by evaluating the long-term outcome. METHODS: One hundred consecutive patients, who underwent a bilateral Endoscopic Sinus Surgery procedure, received follow-up in a prospective, double-blinded way. Cutting forceps had been randomly used on one side and non-cutting forceps on the other side. Lateralised symptoms (headache, maxillary pressure, nasal obstruction and secretions) and endoscopic findings (secretion, pus, blood, crusts, oedema, polyps and adhesions) were evaluated on both sides 1 year postoperatively. RESULTS: Both types of instruments gave satisfactory healing situations. Similar to the short-term follow-up results, no significant difference in the global symptom and endoscopic score between the 2 types of instruments was found. The analysis of individual symptoms and endoscopic parameters also showed no difference. CONCLUSION: Cutting forceps do not result in a better subjective or endoscopic healing evaluation after one year, compared to non-cutting forceps.

Double-Blind Method↗

PubMed1991

Controlled-tension suture-tying forceps.

Suture-tying forceps have been designed to enable surgeons to tie consecutive sutures to the same tension to create an evenly compressed wound. The tensioning effect of the forceps was tested by tying a suture to the end of a cantilever beam strain-gauge device. Three sutures were used: 10/0 nylon, 8/0 polyglactin (Vicryl) and 8/0 virgin silk. The tests were repeated, coating the tips with citrated blood, sodium hyaluronate and saline. Adjustment of the forceps altered the suture tension in 0.015-N steps. Sterilization of the forceps by ethylene oxide or by an autoclave caused no obvious regression in the forceps performance. When the suture and surface lubricant remain constant, there is a linear relationship between forceps setting and the tension induced in the suture.

Calibration↗