Post-operative review OSCE

Eponymous Surgical Instruments

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Introduction

Despite there being a drive to move away from the use of eponyms, many surgical instruments are named after the surgeon who first designed and patented them. Here, we have compiled a list of common eponymously-named instruments as well as a little information about the surgeon from which they are named – this may help act as a memory aid.
In addition to their eponymous name, instruments are often also referred to with a generic name, such as “fine-toothed dissecting forceps” for Adson’s, or “large curved handheld retractor” for a Deaver. Unfortunately, it is not possible to describe all surgical instruments in generic terms.
To further complicate things some generic names may refer to more than one instrument, and some instruments have several different eponymous names. This is because historically, surgeons and manufacturers wanted to cash in on the lucrative business of “inventing” and patenting useful surgical instruments (which were often remarkably similar to one another). Nowadays, most instruments tend to be known by a single universally accepted name; however, cases of alternative names have also been included below.


Dissecting forceps

The two main types are “non-toothed” and “toothed.”

Non-toothed forceps

Non-toothed forceps have serrated or grooved inner grasping edges which allow them to hold tissues without damaging them (Figure 1). They are used for delicate tissues such as vessels, nerves and bowel. This instrument should be handled with great care, as it generates greater pressure between its’ jaws (vs. toothed forceps), making delicate tissues extremely vulnerable to crush injury if too much force is applied. Some eponymously-named non-toothed forceps are described below.

Non-Dissecting Forceps
Figure 1. Non-dissecting/toothed forceps

DeBakey

Long non-toothed forceps (18cm) widely used in general surgery and vascular surgery (Figure 2). Michael Ellis DeBakey was an American cardiothoracic and vascular surgeon who, in a career spanning 75 years and 60,000 operations, revolutionized his speciality. As well as inventing his forceps, DeBakey was first to recognise the link between smoking and lung cancer and he performed the first-ever carotid endarterectomy. Similarly, he devised the DeBakey procedure for aortic dissections. Debakey then underwent his own self-named procedure and survived at the age of 97!1

debakey forceps
Figure 2. Debakey forceps

McIndoe

Medium-length fine non-toothed forceps (15cm) widely used in general surgery and vascular surgery. Less-frequently encountered, a toothed variety is also available. Sir Archibald McIndoe was a plastic surgeon from New Zealand, best known for his work treating RAF fighter pilots with major burns during WWII. A group of his patients and colleagues formed a drinking club called the “Guinea Pig Club”, which still meets for the occasional beer 65 years later.2

Adson

Short fine non-toothed forceps (12.5cm) widely used in neurosurgery, ENT and plastic surgery, when handling more delicate tissues. Alfred Washington Adson was a pioneering American neurosurgeon, giving his name to a number of syndromes and manoeuvres, including Coffey-Adson syndrome – more commonly known as thoracic outlet syndrome. He worked at the Mayo Clinic from 1914 until his death in 1951.3
*Less commonly used non-toothed forceps include: generic very long non-toothed forceps (20-25cm), extremely long St Mark’s Hospital forceps (29cm) and Russian pattern forceps (which have oval cup-shaped ends), Gillies, Canadian, Emmett’s, Iris, Maingot, Moorfield fixators, Ramsey, and turn-over-end forceps.

Toothed forceps

Toothed forceps have one or more sharp triangular “teeth” on their inner grasping edges which interdigitate with one another when the forceps are closed (Figure 3). They pierce tissues and allow them to be grasped firmly with the application of less pressure than is required with non-toothed forceps. This reduces the risk of crush injury. Toothed forceps are used for tougher tissues which can tolerate being punctured, such as skin, subcutaneous fat, fascia, muscle and tendons. This instrument should not be used on vessels, nerves or bowel, as puncturing these could lead to clinical complications.

Figure 5. Dissecting Forceps (toothed)
Figure 3. Dissecting forceps (toothed)

Adson toothed

Short fine-toothed forceps (12.5cm) widely used for delicate work in plastic surgery and neurosurgery (Figure 4). You will remember the ever-industrious Alfred Washington Adson from our exciting encounter with his non-toothed forceps above.

Adson toothed forceps
Figure 4. Adson toothed forceps19

Gillies

Medium-length fine-toothed forceps (15cm) widely used in general surgery, vascular surgery and plastics (Figure 5). A non-toothed variety is also available but is less commonly encountered. Sir Harold Gillies was a New Zealand ENT surgeon, based in London, who is largely considered the “father of plastic surgery.” He pioneered facial reconstructive surgery for horrifically injured soldiers during WWII and performed the first female-to-male sex change operation in 1945.4 He was also Archibald McIndoe’s cousin.

gillie's forceps
Figure 5. Gillie’s forceps

Jean’s

Medium-length toothed forceps (14-18cm) with up to three teeth, inwardly-bent ends and a line of circular holes running along their arms, used in general surgery. Less-frequently encountered, a non-toothed variety is also available. Despite having looked for the mysterious “Mr Jeans”, no information can be found about him. It may instead be that they are not named after an individual – as suggested by the description of an original Jean’s forcep held in a museum. Hopefully, their characteristic appearance alone will help you to remember them.

Waugh

Long fine-toothed forceps (20cm) widely used in general surgery and ENT. A non-toothed variety is also available but is less commonly encountered. Alexander Waugh was by all accounts, a fearsome drunken brute of a man whose surgical notoriety peaked with the invention of his forceps. He was also the grandfather of the novelist Arthur Evelyn Waugh best known for his novel ‘Decline and Fall’.5

Lanes

Heavy toothed forceps (12.5-20cm) with up to 3 teeth, widely used in general surgery and orthopaedics for grasping tough thick tissue and manipulating large needles (e.g. when closing a laparotomy wound) (Figure 6). Sir William Arbuthnot Lane was an English baronet who mastered ENT, orthopaedic and abdominal surgery whilst working at Guy’s Hospital in London. He is best known for pioneering aseptic technique, internal fixation of fractures, neonatal cleft palate repairs and colectomy techniques. One colleague described him as “a master who dared where others quailed”.6

lanes toothed forceps
Figure 6. Lanes toothed forceps19

Bonney

Long, heavy-toothed forceps (18cm) (similar to Lanes), widely used in general surgery and orthopaedics. Victor Bonney was a British gynaecologist who led the way in radical hysterectomy for cervical cancer, fertility-preserving uterine myomectomy for fibroids and ovarian cystectomy. He remains the only gynaecologist ever to be elected to the council of the Royal College of Surgeons.7
*Other less commonly used toothed forceps include: extremely long St Mark’s Hospital forceps (29cm), Leedham Green (4 teeth), Bickford, Braithwaite, Continental pattern, Iris, Ramsey, and Treves’ forceps.


Forceps

As discussed in the general surgical instruments article, forceps are shaped much like scissors except instead of two opposing blades the working ends of forceps oppose each other much like the dissecting forceps.
The benefit of the forcep shape is that it incorporates a ratchet allowing for tissue to be grasped and held by the instrument easily. As you’ll note in the below instruments, the working ends of forceps vary to a much greater extent than simple dissecting forceps. You may also hear some of these forceps referred to as ‘clamps’ or ‘haemostats’ – this reflects their use for clamping down onto tissue or compressing an artery to stop bleeding.
There are a number of medium length forceps which all appear extremely similar to each other, the Kelly, Dunhill and Birkett are just a few. The ‘Birkett’ which is named after the British surgeon and early pioneer of histopathology John Birkett12 whilst the ‘Dunhill’ forcep is most likely named after Sir Thomas Peel Dunhill a thyroid surgeon and physician to the Queen.14

Allis

A long thin clamp with sharp teeth used to hold heavy tissues such as fascia, breast or bowel tissue without damaging underlying tissues. Created by Oscar H. Allis, a pioneering general and orthopaedic surgeon who was the first to successfully perform bowel anastomoses. Allis is also known as the originator of the Allis sign, also known as the Galeazzi test, an assessment of hip dysplasia in children.8

Babcock

Medium length forceps with widened ends. The Babcock forcep has one of the most iconic shapes and is designed to grasp delicate tissues without causing trauma. William Babcock, an obstetrician and gynaecologist turned surgeon is also known for performing a cranioplasty – or closure of the skull – using ‘soup bones’.9

Lanes

Medium length forceps with a single toothed end. Lanes, in my opinion, look like a combination of an Allis and a Babcock, a wide working end that tapers down to a single tooth. Used commonly throughout general surgery, this instrument is named after the same Lane as its dissecting forceps counterpart.6

Mosquito

A small length forceps with a curved or straight end featuring small interlocking ridges lining the jaws. Mosquito forceps are haemostatic forceps designed for controlling bleeding and handling small blood vessels during surgery. Known also as the ‘Halsted-mosquito’ these forceps were invented by William Halstead, a founder of John Hopkins, an early proponent of aseptic technique and champion of anaesthetics. Unfortunately, as a result of experimenting with early anaesthetic drugs, he became addicted to both cocaine and morphine.10

Kelly

Medium length forceps with small interlocking ridges lining long straight or curved jaws. Dr. Howard Atwood Kelly was an American gynaecologist and one of the founding professors at Johns Hopkins University. He also collected snakes as a hobby and was famous as a hardcore Christian fundamentalist who called prayer meetings before every operation and staunchly opposed any form of birth control.11

Littlewoods 

Medium length forceps with small interlocking teeth on the end of the longer arm. These forceps were designed to hold the skin edges of an abdominal wound by Harry Littlewood, a professor of surgery in Leeds. He is also the presenter of the first-ever recorded ‘ovarian gestation’ – where an ectopic pregnancy progresses within the ovary itself.13

Roberts

Long straight or curved forceps with small ridges lining the jaws. The Roberts forcep is like a large version of the Birkett/Kelly forcep (or an XXL version of a mosquito). These forceps are haemostatic and used to compress large blood vessels. Named after David Lloyd Roberts a gynaecologist and collector of books, upon his death he bequeathed over 3000 medical texts to the Royal College of Physicians in London.15

Allis, Babcock and Littlewoods
Figure 7. Forceps, from left to right: Allis, Babcock and Littlewoods

Scissors

Surgical scissors are extremely varied in shape for something as simple as a scissor, this is due to their many uses – for cutting different tissues at different angles, but also for cutting suture thread or other materials needed during surgery. Often scissors have black or coloured handles to make them easy to identify.

Mayo

A short and relatively ‘fat’ pair of scissors compared to others, available in both curved and straight blades, mayo scissors are used for cutting tissues near the surface of wounds. If you’re assisting a surgeon by cutting their sutures, you’ll probably be using Mayo scissors. The Mayo scissors were developed originally by surgeons at the famous Mayo Clinic.16

Metzembaum

The most common scissor in organ-related operations, these scissors are relatively short-bladed compared to their long arms and often have a blunt tip. Used for blunt dissection (separate of tissue) and delicate cutting they are named after Myron Firth Metzenbaum, an American surgeon who specialised in oral and reconstructive surgery.16 You may hear them referred to as ‘Metz’.

Jameson’s

A long scissor, similar to the Metz. The scissor blades are thinner to allow more specific dissection at depth inside the abdomen. The Jameson scissor may be named after James Jameson, a British army officer and founder of the Royal Army Medical Corps.18

Potts

Sharp pointed scissors with a bevelled outer edge, allowing for both blunt and sharp dissection without changing instruments. The Pott’s scissors are one of the many instruments invented by Willis J. Potts, a paediatric surgeon and creator of the aortopulmonary artery shunt – a treatment that prolonged the lives of many children with cyanotic heart disease.19

Surgical scissors, from left to right: Metz curved, Jamieson's, Metz straight, Mayo curved and straight, Potts
Figure 8. Surgical scissors, from left to right: Metz curved, Jamieson’s, Metz straight, Mayo curved and straight, Potts

Retractors

Retractors are used to hold incisions open and move structures such as skin, fascia and internal organs out of the way. They are essential surgical instruments, as they ensure optimal exposure of the operative field. This maximises the surgeon’s visibility and ability to safely reach deep structures, and provides a bigger workspace for dissection, suturing and knot tying. Retractors can be categorised into “handheld,” “self-retaining” and “table-mounted”.

Handheld retractors

Cat’s paw (a.k.a Volkmann/Senn-Mueller/rake retractor)

This is a small handheld retractor with one to six curved toothed blades, commonly used for retraction of small delicate incisions in plastics, hand surgery, vascular surgery and ophthalmology. The teeth can be either blunt or sharp, so do try not to stab yourself!

Langenbeck

Thin, right-angled handheld retractors which are available in several sizes ranging from small (or “baby”) to large, probably used in every surgical speciality…with the exception of ophthalmology. They are extremely useful instruments which are used to retract or lift superficial wound edges. Bernard von Langenbeck was a German military surgeon famous for developing the world’s first surgical “residency” programme for trainees at his hospital in Berlin.20

Langenbeck retractors
Figure 9. Langenbeck retractors19

Morris

Medium-sized, right-angled handheld retractors, available in a range of sizes (can be single-bladed or double-bladed). These are commonly used to retract larger incisions in thoracic, abdominal and pelvic surgery. Sir Henry Morris was a British urologist who pioneered nephrolithotomy for renal calculi and was President of both the Royal College of Surgeons and the Royal Society of Medicine from 1910-1912.21

morris retractor
Figure 10. Morris retractor19

St Mark’s hospital

Large, right-angled handheld retractors with a lip at the end of their long blades to help lift and protect the organs being retracted (Figure 11). Some designs also have a groove which can be used to hold a fibreoptic light source. These are used to retract wound edges and organs during deep abdominal and pelvic surgery. St Mark’s Hospital in London began in 1835 as a seven-bedded “Infirmary for the Relief of the Poor afflicted with Fistula and other Diseases of the Rectum”, and is now a world-renowned specialist centre for patients with intestinal and colorectal disease.22

St Mark's retractor
Figure 11. St Mark’s Retractor19

Moynihan

A small, curved handheld retractor, similar in function to a Langenbeck and used for retracting superficial wound edges in general and orthopaedic surgery. Sir Berkeley Moynihan was a celebrated British general surgeon and anatomist who founded the Association of Surgeons and British Journal of Surgery.23

Doyen (a.k.a bladder retractor)

A medium-sized, roundly curved handheld retractor classically used to retract the bladder downwards and keep it covered during a lower segment Caesarean section (Figure 12). It is also widely used in general surgery and obstetrics and gynaecology to retract the bladder and other internal organs. Eugène-Louis Doyen was a controversial French surgeon, fencer and sharpshooter who developed surgical instruments and techniques which allowed him to operate with legendary speed and minimal blood loss at a time when anaesthetics were deadly and artificial ventilation did not exist. He also produced some of the first films of surgical operations, including the separation of conjoined twins in 1902.24

doyen retractor
Figure 12. Doyen retractor

Deaver

A large curved handheld retractor available in a range of sizes and widely used in general surgery to retract wound edges and abdominal organs. A wet swab (see disposables) or pack is often placed as an interface between the retractor and any solid organs, to minimise the risk of iatrogenic trauma. Dr John Blair Deaver was an American general surgeon who pioneered techniques in the surgical management of early acute appendicitis. He was a viciously witty and much-loved teacher, although his trainees soon became sick of holding his heavy retractor for long periods, calling it “Death by Deaver.25

Kelly

A long, curved handheld retractor used in general surgery to retract deep abdominal and pelvic structures, for example during anterior dissection of the rectum. Dr. Howard Atwood Kelly was an American gynaecologist and one of the founding professors of Johns Hopkins University. He also collected snakes as a hobby and was famous as a hardcore Christian fundamentalist who called prayer meetings before every operation and staunchly opposed any form of birth control.11

Harrington (a.k.a sweetheart)

A long, heart-shaped handheld retractor used in general surgery to retract deep organs such as the liver and intestines. Dr Paul Randall Harrington was an American orthopaedic surgeon, best known for developing Harrington spinal rods for the correction of scoliosis in survivors of the US polio epidemic.26
*Other less commonly encountered handheld retractors include Canny-Ryall retractors, Czerny retractors, Durham retractors, and US Army retractors.

Self-retaining retractors

Self-retaining retractors all have a similar appearance – two long-toothed arms that spread apart which are held in place via a ratchet. These allow retraction of tissues for long periods of time and do not require a surgeon to hold them, as they can rest against the patient’s body.

Norfolk-Norwich

A self-retaining retractor involving 4-5 interlocking teeth at the end of long arms typically used in vascular surgery. Named after a hospital in the South-East of England, these were likely first implemented or used there.

norfolk-norwich retractors
Figure 13. Norfolk-Norwich retractors19

Travers

Travers are similar in shape to a Norfolk-Norwich retractor; however slightly smaller in form. There are two famous, though unrelated, surgeons by the name of Travers. Benjamin Travers, arguably one of the first ophthalmologists, and William Travers after whom this retractor is likely named. William Travers was an obstetrician and gynaecologist who was one of the founders of the British Gynaecological Society.27

Weitlaner

Weitlaner’s are a smaller form version of the Norfolk-Norwich or Travers retractors. Named after Franz Weitlaner, often mistakenly named ‘Weitlander’, an Austrian surgeon who was often found operating alone, and so invented this handy retraction aid.28

weitlander retractor
Figure 14. Weitlaner retractor

Table-mounted retractors

A larger form of the self-retaining retractor is the table-mounted retractor. These screw or clamp onto the operating table and can retract tissue from a wide range of angles for long periods of time.

Layla retractor

This is a famous example invented by Mahmut Yasagil after he was inspired by his daughter’s wooden articulating toy snake. The snake had a string running through the middle which, if pulled taught, would hold the wooden segments in position regardless of the snake’s orientation. Yasagil is considered to be one of the greatest neurosurgeons of the twentieth century.29

Thompson-Farley and Omnitract, Bookwalter

These retractors are other examples of complex table-mounted retractor systems, they are commonly used in large complex abdominal operations.


Conclusion

There are, of course, many more instruments with eponymous names- too many to go through in one article! If you ever see instruments being used which you’ve never seen before or don’t understand the use of, ask!  The scrub staff are extremely knowledgeable about instruments. If you have questions about the specific uses of instruments – I would strongly recommend being inquisitive – you’ll look interested and it’s a great way to get to know the team better.

The best way to get familiar with instruments is to handle them, which means scrubbing in and assisting in operations. Good luck!

Check out our general surgical instruments quiz to put your knowledge to the test!


References

  1. Oransky I. Michael E DeBakey. The Lancet. Published in 2008. Available from: [LINK].
  2. Pinney JA, Metcalfe AD. Sir Archibald McIndoe and the Guinea Pig Club. Published in 2014. Available from: [LINK].
  3. Adson AW, Coffey JR. Cervical rib: a method of anterior approach for relief of symptoms by division of the scalenus anticus. Published in 1927. Available from:[LINK].
  4. Matthews DN. Gillies: Mastermind of modern plastic surgery. Available from:[LINK].
  5. Acocella J. The New Yorker. Waugh Stories. Available from:[LINK].
  6. Brand RA. Clinical Orthopaedics and Related Research. Sir William Arbuthnot Lane. Available from:[LINK].
  7. Philipp EE. Book Review: Victor Bonney: The Gynaecological Surgeon of the Twentieth Century. Available from: [LINK].
  8. Allis, O.H., McReynolds, R.P., Oscar Huntington Allis. Published in 1986. Available from:[LINK].
  9. Sandler AL, Biswas A, Goodrich JT. The Reverend Russell H. Conwell, W. Wayne Babcock, and the “Soup bone” cranioplasties of 1915. Published in 2014. Available from:[LINK].
  10. Cameron JL. William Stewart Halsted. Our surgical heritage. Published in 1997. Available from:[LINK].
  11. Nweze I, Shukry S. Howard Atwood Kelly: Man of Science, Man of God. Published in 2017. Available from: [LINK].
  12. Royal College of Surgeons of England. John Birkett Obituary. Published in 2006. Available from:[LINK].
  13. Royal College of Surgeons of England. Harry Littlewood Obituary. Published in 2012. Available from:[LINK].
  14. Royal College of Surgeons of England. Sir Thomas Peel Dunhill Obituary. Published in 2014. Available from:[LINK].
  15. The National Archives. David Lloyd Roberts. Published in 1923. Available from:[LINK].
  16. History of the Mayo Clinic. Available from: [LINK].
  17. Metson R. Myron F. Metzenbaum, MD: Innovative Surgeon, caring physician. Published in 1994. Available from: [LINK].
  18. Royal College of Surgeons of England. James Jameson Obituary. Published in 2012. Available from:[LINK].
  19. Raffensperger J. Potts and Pott: Surgeons and Innovators. Published in 2020. Available from:[LINK].
  20. David M, Ebert AD. Instrumente und ihre Namensgeber. Bernhard von Langenbeck und die Langenbeckʼschen Haken. Published in 2012. Available from: [LINK].
  21. Royal College of Surgeons of England. Sir Henry Morris Obituary. Published in 2006. Available from:[LINK].
  22. St Mark’s Academic Institute. About Us. Available from:[LINK].
  23. Royal College of Surgeons. Sir Berkeley George Andrew Moynihan Obituary. Published in 2006. Available from: [LINK].
  24. Powell JL. Powell’s Pearls: Eugène Louis Doyen, MD (1859–1916). Available from: [LINK].
  25. Deaver JB. John Blair Deaver. Diseases of the Colon & Rectum. Published in 1987. Available from:[LINK].
  26. Hall JE. Spinal surgery before and after Paul Harrington. Published in 1998. Available from: [LINK].
  27. Royal College of Surgeons. William Travers Obituary. Published in 2012. Available from: [LINK].
  28. Sharma A, Swan KG. Franz Weitlaner: The Great Spreader of Surgery. Published in 2009. Available from: [LINK].
  29. Tew J. M. Gazi Yasagil: Neurosurgery’s Man of the Century. Published in 1999. Available from:[LINK].

Acknowledgements 

Many thanks to Bethanie William ODP for supplying images of instruments (Figures 6-11).


Reviewer

Mr Robert Pearson

General Surgery Registrar


Editor

Hannah Thomas


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