Surgical Forceps: Definitive Guide on Each Type

Surgical forceps are basic tools in any type of medical procedure, from minor interventions to highly complex operations. Knowing each of the types available in the current market provides a superior advantage to ensure the success of any surgery. In this article, we will delve into the different types of surgical forceps and remember the benefits that each of them offer and the indications that should be followed to use them.

Surgical forceps, the first contact with the patient

In the operating room, surgical forceps are more than just simple instruments to operate with. For surgery professionals, forceps are useful appendages that replace hands in processes that require precision, allowing to hold, remove or retract all kinds of tissue fold or foreign body.

Surgical forceps are usually made with medical grade stainless steel and matte finish to avoid glare in the operating room. This material also ensures that their reprocessing and subsequent sterilization do not compromise their integrity, being able to be reused indefinitely without losing quality. However, forceps made with other materials can also be found, such as:

• Titanium: highly valued in fields such as microsurgery or neurosurgery for its extreme lightness and resistance to corrosion. It is a non-magnetic metal and conducts heat to a lesser extent than steel, so it can be a very useful option in long-term interventions or in operations that must be performed next to heat sources
• Tungsten carbide: is usually used only to reinforce the grip areas and is not used to manufacture the entire forceps. Its use provides greater hardness and resistance to the forceps and improves its holding capacity, preventing accidental slips during the procedure and optimizing its resistance to wear derived from continuous use. It is a highly coveted material in procedures that require superior precision and is usually reserved for needle holders, dissection forceps and holding instruments.

• Plastics and derivatives: are used only for the production of disposable forceps for care kits, simple outpatient procedures and minor interventions. They are the most economical in every sense, as they have a lower manufacturing cost and do not need to be reprocessed after their use. However, they are less resistant and precise, so they are only used in specific cases and in superficial procedures.

Types of surgical forceps

Beyond the material with which they are produced, the main difference between the different types of surgical forceps lies in their shape, their closing mechanism and their function. Three classifications are established: according to their jaw, according to their type of closure and according to their generalized design. 

Types of forceps according to their jaw

The jaw is the part of the surgical forceps in which both ends join to hold an object or tissue fold. They can be smooth, curved or angled, depending on the area to be intervened, and they can have a smooth, striated or tooth-reinforced surface:

• Striated tip forceps: one of the most common subtypes in surgery. They are very useful because they offer superior adhesion to tissues, so they are perfect for retracting skin folds or temporarily sealing blood vessels. They are usually the tips used in the manufacture of hemostatic forceps and, although they offer optimal grip, they can also end up damaging the tissue, so they are not recommended for delicate interventions.

• Smooth tip forceps: they are the most atraumatic, so their use does not expose tissues to risks of perforation or tearing. They are the ideal model for when sensitive tissues must be manipulated or when gauze or other dressings must be placed on wounds. However, they offer less grip compared to other models and slippage can occur during their use if they are used to hold organs or wet tissues.
• Toothed tip forceps: forceps with teeth have a mechanism in the jaw with several sharp protrusions that fit together when pressure is applied. Despite their traumatic nature, they are widely used in interventions where there are no delicate tissues involved, such as in skin, muscle or tendon surgeries. They are completely contraindicated in cases where internal organs must be operated on or where blood vessels or sensitive tissues are involved.

Beyond this classification, there is a fourth subtype that can be combined with the rest of the classes. These are the fenestrated jaws, which incorporate a small opening at the tip to increase the contact surface and distribute the pressure optimally. In this way, excessive compression of the grip area is avoided, minimizing the risks of injury during the intervention; due to their features, they are often used for sensitive organs and tissue masses.

Types of forceps according to their closure

The closure is a mechanism that some models incorporate to keep the jaws together without the need to apply constant pressure. This is an excellent advantage in operations where multiple instruments must be used continuously and in long-term interventions. According to the type of closure, the forceps are divided into:

• Spring forceps: incorporate a metal spring that keeps the jaws together if pressure is not actively applied. Although it is an effective system, it is not as comfortable as other closures, so it is usually reserved for hemostatic forceps type clamp-bulldog.
• Zipper closure forceps: otherwise called forceps with ratchet or rack closure, they have a series of teeth at the base that, when fitted, allow the jaws to be kept closed in several predetermined positions. To unlock them, simply move the rings at the base in opposite directions. It is a very common mechanism in hemostatic forceps and needle holders.

• Locking forceps: similar to those with a ratchet system, locking forceps have a single closing step that keeps them pressed without the need to apply constant force. They are very useful in situations where a specific and fixed pressure is required; the best-known case is that of the forceps used to compress the umbilical cord.
• Screw closure forceps: include a screw in the handle that can be adjusted according to the piece of tissue being held. They offer optimal, reliable and durable grip; however, their manipulation is less comfortable and practical.

Types of forceps according to their function

The shape, the actuation mechanism and the design of the tip of a surgical forceps are directly correlated with its functionality and with the type of procedure to be performed. Among the different types of forceps that exist according to their use, are:

• Dissection forceps: as their name indicates, they are used to hold and retract tissue folds during dissection procedures. They can contain teeth or have a striated surface, depending on the type of tissue mass to be held. The most common model is the Adson forceps, characterized by having a reduced size and fine tips to be able to operate with greater precision and practicality in smaller operating fields.
• Field forceps: are used to place and fix sterile drapes or fields around the intervention area. They can have sharp or spherical tips, depending on the need for grip required for the intervention. In many cases, they can incorporate springs or ratchet system to remain occluded without the need to apply constant pressure, facilitating the operation.

• Needle holders: are used to hold suture needles during wound stitching procedures. They usually incorporate ratchet closures and striated tips to facilitate the grip of the needle and make the process easier.
• Watchmaker's forceps: so called because they were used in the repair and production of watches, the watchmaker's forceps have exceptionally fine tips and extremely thin and light bodies. This combination of characteristics makes them ideal for the manipulation of delicate tissue fragments, the removal of small foreign objects and the grafting of hair fibers.