• “tweezer-like” instruments
  • used to manipulate tissues and needles
  • when used properly
    • cause less trauma than fingers
    • allow more accurate manipulation of tissues,needles, and suture

Skills to Practice

  1. pencil grip hold
  2. atraumatic, efficient manipulation of "tissues"
  3. efficient extraction of needle tip from tissues during suturing


Tissue forceps are used to:

  • manipulate tissues
  • support tissues while making incisions, and suturing
  • retract tissues to improve exposure
  • grasp suture materials and needles
  • “ become your fingers in most cases” as usually less traumatic, more accurate and faster
  • a variety of size and designs


Adson tissue forceps Brown-Adson forceps Rat tooth or tissue forceps DeBakey forceps

Thumb Forceps

  • Small grooves, but no teeth on the tips
  • Hold tissue by pressure applied to the handles
  • Amount of trauma (crushing) varies with
    • amount of pressure
    • size and design of tips and grooves

Thumb forcep tipsThumb Forcep tips

Tissue forceps

  • tips have small teeth
  • size and number of teeth vary
  • teeth penetrate tissue to hold it
  • preferred by most surgeons over thumb forceps because:
    • less crushing injury
    • more secure hold with less finger pressure

Types of Forceps

Considerations in Forcep Selection

  • size and design of tips
  • length of handles
  • security of hold relative to the pressure exerted
  • amount of tissue trauma induced
  • tissue being manipulated
  • depth of area working in
  • surgeon preference

Adson tissue forceps Brown-Adson forceps Rat tooth or tissue forceps DeBakey forceps


  • also called "rat tooths"
  • strong tips
  • described by the number of teeth present  (eg. 2x1 or 2x3)
    • useful to manipulate heavy tissue (eg. fascia)
    • Large teeth make them inappropriate for delicate tissues. 



  • fine tips with broad handles
  • smaller size more appropriate for small animals
  • 2 x 1 (2 teeth on one tip, 1 tooth on other arm)
  • provide a secure, delicate grasp with minimal crushing injury


  • fine tips with broad handles
  • multiple columns of fine interlocking teeth
  • provide a delicate, but secure, grasp
  • also useful for manipulating small needles during suturing


DeBakey thoracic

  • series of longitudinal and transverse grooves
  • designed to atraumatically manipulate vessels and fragile tissues
  • useful for manipulating needles during suturing


A variety of forceps with ringed handles and locking mechanisms are available for manipulating tissues.  These are useful for prolonged grasping and tissue manipulation as long as the amount of tissue trauma induced is considered.  Less traumatic alternatives include stay sutures, the assistant’s hands or fingers and non-crushing forceps or tissue retractors.  

Allis tissue forceps

  • provide a secure hold for prolonged periods
  • have a series of interlocking teeth along the tips
  • ring handles with a ratchet locking mechanism
  • grasp tissue by a combination of crushing and teeth interdigitation
  • traumatic so restrict use to tissue being excised

Babcock forceps

  • similar design
  • grasping surface consists of a series of longitudinal grooves
  • less traumatic but hold less securely  


Holding the forceps

  • held in the non-dominant hand with a pencil grip
  • thumb and index finger placed on handles
  • handles rest on remaining fingers
  • grip allows accurate manipulation, flexibility and fine pressure adjustment

Pencil Grip

  • avoid holding with a palm grip which may at first may feel more natural because:

Palm Grip

  • hampers maneuverability
  • less efficient
  • grasp applies more pressure causing more crush injury

How to Use

Using tissue or thumb forceps

  • grasp the minimal amount of tissue that provides a secure hold with the least amount of pressure
  • avoid handling skin when possible (bruises easily)
    • handle the subcutaneous tissue instead

To minimize trauma

  • limit the number of times tissue is grasped
  • minimal pressure of hold
  • minimize duration held
  • Use stay sutures if need repeated or prolonged manipulation

  • When not in use, hold in palm of non-dominant hand

Skills to Master

  • correct hold of the tissue forceps (pencil grip, NOT palm grip)
  • manipulating "tissues"
  • extracting needles from tissue during suturing

Practice: Tissue Forceps

  1. pick up small round objects (e.g. beads, pepper corns, sesame seeds) and place in container until hold is comfortable and accurate
  2. pick pulp out of an orange section
  3. hold forceps in palm of hand while perform instrument knot (during lab 2)
  4. extract needle from "tissue" during suturing (during lab 3)