Heaney Clamp
A ring-handled, ratcheted pedicle clamp used for clamp-cut-ligate steps in vaginal and open hysterectomy. The curved pattern is familiar on the vaginal-surgery tray; its jaw surface, groove configuration and length depend on the manufacturer and model.[1][2] It is one of three instruments that carry the name of Noble Sproat Heaney, with the Heaney needle driver and the Heaney retractor.
Design and variants
Choose the actual jaw pattern for the exposed pedicle and available working space. The eponym alone does not establish its geometry.[1]
| Pattern | Verified manufacturer examples | Practical distinction |
|---|---|---|
| Heaney | Pilling 214170/214172/214175: curved, 21 cm; light or heavy jaws; single or double groove | Serrated gripping surfaces with a cross-groove; inspect the actual jaw rather than assuming a universal tip-tooth arrangement |
| Heaney-Ballantine | Pilling 214180: straight, 21 cm; 214182: curved, 20.5 cm; longitudinal serrations and a single groove | Available in straight and curved forms; the name does not mean a mandatory double curve |
| Extended-length Heaney-Ballentine | Pilling 175038/175039: curved or straight, 30.5 cm | Longer reach is a model choice, not a requirement of every vaginal case |
| Masterson | Pilling 175059/175060: curved or straight, 25.5 cm | Another hysterectomy-forceps family; there is no universal straight-Masterson/curved-Heaney division by surgical route |
The ratchet maintains closure; the box joint is the hinge. These are separate features. A ratchet position is not a calibrated measure of tissue pressure.
Use during pelvic reconstruction
When hysterectomy forms part of the operative plan, Heaney clamps can secure uterosacral and cardinal, uterine-vessel and upper uterine pedicles. Pedicles may be taken separately or in appropriate combinations according to the operation, exposure and tissue bulk. The instrument can be used during the vaginal or open component of a combined procedure.[2] Examples include hysterectomy at the time of sacrocolpopexy or pelvic-floor reconstruction and hysterectomy adjunctive to complex pelvic fistula repair.
Hysterectomy itself is a separate treatment decision. ACOG favors vaginal hysterectomy when feasible for benign indications, with laparoscopy preferred over an open abdominal route when a vaginal approach is unsuitable. Anatomy, concurrent procedures, surgeon experience and patient preference influence that decision; clamp availability does not determine the route.[3]
Clamp-cut-ligate principles
- Expose and identify the intended pedicle. Define the adjacent bladder, bowel and ureteral course before committing to the bite; additional dissection may be necessary when anatomy is distorted.
- Seat the pedicle within the jaws. Avoid an oversized bite, tissue crowded into the joint, or traction that could avulse the pedicle. Confirm that surrounding structures are excluded.
- Divide on the specimen side of the controlling clamp, retaining enough tissue for a secure ligature.
- Ligate the retained pedicle, using a ligature or transfixion technique appropriate to its tissue and vascularity. Release the clamp in a controlled fashion as the ligature seats, then inspect for bleeding and slippage.
These principles summarize clamp use; the order of colpotomy, individual pedicles and apical-support sutures varies among hysterectomy techniques. The published ten-step method is one described approach.[2]
Ureteral protection depends on identifying the anatomy. Staying close to the cervix or uterus during appropriate benign pedicle dissection is useful, but jaw curvature cannot guarantee safety. A cadaveric study distinguished the distal cardinal-ligament attachment from its more lateral ureteral, neural and vascular relationships; its average dimensions are not an individual patient's safe clamping distance.[7]
The Heaney technique
Heaney described a stepwise vaginal hysterectomy in which each pedicle is clamped, divided on the uterine side and ligated before the next is taken. In his 1940 account, the posterior cul-de-sac is entered first through a transverse incision behind the cervix. A slender curved clamp is then placed across each sacrouterine ligament, which is divided on the uterine side and replaced by a fixation ligature. The lower broad ligament above it is taken the same way. With the cul-de-sacs opened, the uterine vessels are clamped and ligated under direct vision. The upper broad ligament is clamped last and includes the suspensory ligament of the ovary, the uterine end of the tube and the round ligament.[8]
The sequence is a historical description. Current technique varies in the order of colpotomy, pedicle combination and apical-support sutures, as noted above.
Vessel sealing versus suture ligation
The 2024 Society of Gynecologic Surgeons systematic review included 116 studies of several vaginal-surgery technologies. In its 19 comparative pedicle-sealing studies, sealing devices reduced estimated blood loss by about 37 mL and operating time by about 16 minutes, with smaller differences in hospital stay and pain. These are vaginal-hysterectomy findings and do not prove superiority in every pelvic operation or compare named clamp patterns.[4]
The earlier 2014 meta-analysis of eight randomized trials (772 patients) found about 49 mL less blood loss, but no statistically significant reduction in operating time or complications; heterogeneity limited certainty. Different reviews include different studies and should not be combined as independent patient cohorts.[5]
Clamp-and-suture ligation remains a useful primary or backup hemostatic method. It applies where energy devices are unavailable, including low-resource settings,[2] as a fallback when a device fails, and in resident training, where clamp-cut-ligate is a foundational skill. Both mechanical clamping and energy devices can injure adjacent structures; select the method for the exposed anatomy and follow the device-specific instructions when using energy.
Limitations and operative cautions
- Crush injury is intentional at a ligated pedicle. Part of that secured stump remains in the patient. This does not make the clamp suitable for temporary atraumatic occlusion of a vessel that must remain patent, or for grasping a ureter, bowel wall or reconstructive flap.
- Infundibulopelvic ligament slippage during oophorectomy. With conventional clamps such as the Heaney, tissue can interpose between the blades near the joint and allow the infundibulopelvic pedicle to slip. This limitation led to the Paily vaginal oophorectomy clamp, whose reversed blades leave no tissue between the blades near the joint (a prospective case series).[9]
- Slippage remains possible. Jaw fit, tissue bulk, ligature placement and traction matter; neither grooves nor a tip tooth guarantee hemostasis.
- Peripartum hysterectomy requires a different operative context. Engorged vessels, edema, friable tissue and displaced ureters complicate pedicle control, particularly with placenta accreta spectrum. Management requires the hemorrhage plan and appropriate multidisciplinary expertise; a clamp choice cannot replace them.[6]
- Weight and length. The clamp is heavy and long, and hand fatigue can occur in long cases.
- Preserve the apical-support plan. Completion of hysterectomy and closure of the cuff do not by themselves define adequate prolapse reconstruction.
Historical context
Noble Sproat Heaney (1880–1955) was a Chicago gynecologic surgeon who promoted vaginal hysterectomy at a time when the abdominal route dominated. His stepwise technique, and the clamp, needle driver and retractor that bear his name, supported the sequential clamp-cut-ligate approach.[8] Vaginal hysterectomy has been re-emphasized as the preferred route for benign disease when feasible.[3]
See also: Heaney Needle Driver, Heaney Retractor, Masterson, Rochester-Péan.
References
1. Teleflex/Pilling. Surgical Instruments Catalog. Printed pages 257, 267–268: Masterson, Heaney and Heaney-Ballantine patterns. Manufacturer catalog.
2. Stark M, Malvasi A, Mynbaev O, Tinelli A. "The renaissance of the vaginal hysterectomy — a due act." Int J Environ Res Public Health. 2022;19(18):11381. doi:10.3390/ijerph191811381
3. Committee on Gynecologic Practice. "Committee Opinion No. 701: choosing the route of hysterectomy for benign disease." Obstet Gynecol. 2017;129(6):e155–9. doi:10.1097/AOG.0000000000002112
4. Balgobin S, Balk EM, Porter AE, et al. "Enabling Technologies for Gynecologic Vaginal Surgery: A Systematic Review." Obstet Gynecol. 2024;143(4):524–537. doi:10.1097/AOG.0000000000005522
5. Pergialiotis V, Vlachos D, Rodolakis A, et al. "Electrosurgical bipolar vessel sealing for vaginal hysterectomies." Arch Gynecol Obstet. 2014;290(2):215–22. doi:10.1007/s00404-014-3238-0
6. Tsolakidis D, Zouzoulas D, Pados G. "Pregnancy-related hysterectomy for peripartum hemorrhage: a literature narrative review of the diagnosis, management, and techniques." Biomed Res Int. 2021;2021:9958073. doi:10.1155/2021/9958073
7. Samaan A, Vu D, Haylen BT, Tse K. "Cardinal ligament surgical anatomy: cardinal points at hysterectomy." Int Urogynecol J. 2014;25(2):189–95. doi:10.1007/s00192-013-2248-y
8. Heaney NS. "Vaginal hysterectomy: its indications and technique." Am J Surg. 1940;48:284–8. Reprint
9. Paily VP, Raj Girijadevi R, K Shefeek S. "Salpingo-oophorectomy during non-descent vaginal hysterectomy using the Paily vaginal oophorectomy clamp." J Obstet Gynaecol Can. 2024;46(3):102281. doi:10.1016/j.jogc.2023.102281