A new dissecting hemostat

A NEW DISSECTING HAROLD

HEMOSTAT*

LAUFMAN,

M.D.

Chicago, Illinois

T

HERE are many surgica1 situations in which a vessel or duct must be dissected bIuntIy yet deIicateIy from the

geons wiII agree that whenever feasibIe they prefer to Iigate behind a cIamp rather than do a Ioop ligation and cut between

FIG. r. A, left-handed model of dissecting hemostat with blades open showing shape of dissecting nose; B, right-handed mode1 with similar view; c, appearance of instrument with blades cIosed; D, full-length view of instrument; modified from Mixter-type forceps.

surrounding tissue before a cIamp is pIaced. The instrument to be described has been developed to simplify and add safety to such dissections. It has been used to advantage particuIarIy in thyroidectomy and choIecystectomy. It is offered as a vaIuabIe adjunct in everyday surgical technic and not as another gadget for occasiona use. The essential feature of the instrument is that it has a sIightIy curved proIongation attached to one of the blades of a curved hemostat. This simpIe modification of the average curved hemostat permits the saving of at Ieast one extra instrument and considerable time in dissection. Most sur* From the Departments

of Surgery,

the ties. The aneurysm needIe is a vaIuabIe instrument because it aIIows for the passing of suture materia1 about a duct or vesse1. However, cutting between free ties is fraught with obvious dangers. The instrument described herein has the advantage of serving as an aneurysm needIe and a cIamp at the same time, thus giving the surgeon the added security of ligating behind a clamp and yet getting around the structure with the same instrument. (Fig. I.) For example, in dissecting the superior thyroid vessels for Iigation it is often necessary to dissect them bluntIy by spreading a hemostat. The hemostat is then held in a

Northwestern University Chicago, III. 864

Medical

SchooI and Michael

American

Reese Hospital,

Journal

of Surgery

Laufman-Dissecting spread position while two other instruments are passed between the open blades to clamp the vessels. Thus one instrument is used for dissection and maintaining a free passageway behind the vesseIs whiIe the other instruments are used to cIamp

Hemostat

@%

ado about the removal of one instrument and the insertion of another. (Fig. 2.) A further source of security to the surgeon in the use of this instrument is that the Iong nose on the bIade makes it considerabIy easier to Iigate the structure in-

FIG. 2. A, cystic duct is dissected free and clamped with one motion; B, by hooking ligature behind dissecting nose of clamp ligation in deep places is facilitated and the ligature cannot slip off the tip of the instrument; c, dissection and ctamping of superior thyroid vessels; D, shows ease of Iigation behind clamp.

the vesseIs. With the new dissecting hemostat it is possible to dissect behind the vesse1 with the blunt nose dissector of the instrument whiIe in the same motion the structure becomes cIamped. In this way the technic is faciIitated and is much less cIumsy. A right and Ieft cIamp make it possibIe to attack the structure from either side. The same situation hoIds in the dissection and cIamping of the cystic duct and cystic artery in choIecystectomy. With one motion the nose of the instrument dissects behind the structure to be cIamped and the clamp is immediateIy cIosed with no more June,

1950

valved since the suture materia1 cannot sIip off the tip of the cIamp because of the additional meta beyond the cIamped structure. This makes it possible to hook the suture materia1 behind it easiIy even in deep pIaces. Dissection can be carried out with the blades either open or closed; and if the structure is Iarge, dissection can be begun with the bIades closed. When the nose of the instrument slips under the structure, the bIades can be open so that the cIamping is done without withdrawing and reinserting the instrument. This design can be appIied in principle

Laufman-Dissecting

866

to modify any curved forceps in use today. Thus the surgeon can adapt this principIe to appIy to Iarger as we11 as smaIIer hemostats. SUMMARY

A new dissecting hemostat is presented which greatIy facilitates the dissection and

Hemostat clamping of certain ducts and vessels. It is particularIy appIicabIe in thyroidectomy and choIecystectomy. It has aIso been used in saphenous vein Iigations and similar procedures. The advantages are enumerated above. The simplicity of the instrument makes for a wide field of appIicabiIity in practica1, everyday surgery.

This articIe was previously published in the March 1940 issue of The American Journal of Surgery. It has been reprinted because of an error in the arrangement of textmatter.

American

Journal

of Surgery