Masterson Pedicle Clamp
The Masterson pedicle clamp is a ring-handled, ratcheted hysterectomy forceps made in straight and curved patterns.[1][2] It is a long, heavy clamp for the broad vascular and ligamentous pedicles of open abdominal hysterectomy, and it is the abdominal counterpart of the Heaney clamp, which is used from below at vaginal hysterectomy.
Design and selection
| Manufacturer example | Configuration | What to check on the tray |
|---|---|---|
| Pilling 175059 | Curved, 25.5 cm | Jaw curve, usable gripping surface and reach |
| Pilling 175060 | Straight, 25.5 cm | Same family, different approach to the exposed pedicle |
| Aspen/Symmetry 37-1521 | Curved, 8½ inches | A shorter manufacturer example; lengths are model-specific |
Both patterns have ring handles, a ratcheted box lock and stainless-steel construction sized for thick pedicles. Confirm jaw dimensions and serrations for the specific model. Manufacturer descriptions establish configuration; comparisons of tissue injury require clinical or biomechanical evidence.[1][2]
The straight pattern can be set perpendicular to the pedicle axis when the surgeon looks down on the pedicle from above. This gives a clean linear crush line and a defined groove for the suture ligature. A curved pattern follows the uterine or cervical contour. These are general handling points, not model-specific claims.
Select by access, tissue bulk, jaw fit and secure ligature placement. Heaney and Heaney-Ballantine patterns offer other geometries; Heaney-Ballantine itself comes in straight and curved forms.[3]
Pelvic-surgery use
A Masterson may be used to control vascular or ligamentous pedicles during hysterectomy, including an open hysterectomy performed with pelvic reconstruction. The hysterectomy indication, ovarian-preservation plan and route determine which pedicles are divided. Operative descriptions emphasize pelvic anatomy and careful tissue handling, with no single required clamp model.[4]
Pedicle sequence in total abdominal hysterectomy
The conventional sequence of open hysterectomy runs from superior to inferior, with a clamp placed on each pedicle in turn:[4]
- Round ligament, divided and ligated to enter the broad ligament.
- Infundibulopelvic ligament when the ovary is removed, or the utero-ovarian ligament and tube when the ovary is preserved.
- Uterine artery pedicle at the level of the internal os, which lies close to the ureter.
- Cardinal and uterosacral pedicles, taken in stages toward the vaginal fornices.
- Vaginal cuff, the last pedicle before the specimen is removed.
Clamp, cut and tie
- Place the clamp across the pedicle, with the tip at the intended transection point. A second clamp or finger traction on the specimen side steadies the pedicle.
- Divide the tissue on the specimen side of the clamp with scissors or a scalpel.
- Place the suture ligature beneath the clamp and tie it as the clamp is released slowly, so that the ligature seats in the crush groove.
- Transfix vascular pedicles, most often the uterine artery, with a stick-tie followed by a free tie, to prevent slippage from the cut end.
Suture material and size are chosen by the surgeon for each pedicle.
Related pelvic reconstruction
The Masterson is used when the abdominal route is chosen for the hysterectomy step of abdominal sacrocolpopexy, complex fistula repair or other pelvic-floor reconstruction. Radical hysterectomy for cervical cancer is usually performed by gynecologic oncologists. In that setting, bipolar vessel sealers have been compared with clamp-and-tie (see the comparative evidence below).
For the general sequence of exposure, clamping, division and ligation, see Heaney: clamp-cut-ligate principles. Keep these points explicit:
- The retained pedicle must remain controlled during division. Cut on the specimen side of the clamp and secure the stump before final release.
- Suture choice and transfixion are procedure-dependent. No one size or material or mandatory free-tie-plus-stick-tie sequence fits every pedicle.
- Crushing can be appropriate for a pedicle being permanently ligated, including its retained stump. This is different from temporary occlusion of a vessel intended to remain patent.
- Identify the ureter in relation to the actual operative field. In a cadaveric study of the cardinal ligament, the ureter lay in the intermediate section, beyond a distal cervical section that averaged 2.1 cm and contained no significant neurovascular structures. A clamp on the uterine-artery pedicle that strays laterally therefore risks ureteral injury. Average measurements cannot supply a fixed safe distance, especially after prior surgery or with distorted anatomy.[5]
What the comparative evidence supports
Evidence about hemostatic methods must be separated from evidence about the hysterectomy route.
| Evidence | Supported interpretation | Important limit |
|---|---|---|
| Tamussino 2005, 52 radical abdominal hysterectomies | The bipolar-sealing group had fewer transfusions | Nonrandomized comparison; operating time did not differ significantly. One ureterovaginal fistula occurred in the sealing group |
| Li 2012, retrospective cohort of 391 radical abdominal hysterectomies for cervical cancer | BiClamp use was associated with lower estimated blood loss and shorter operating time | Observational, cancer-specific evidence; it does not prove benefit in benign reconstruction or establish a Masterson-specific comparison |
| Pickett 2023 Cochrane review, 63 randomized trials, 6,811 women | Compares hysterectomy routes for benign disease, favoring vaginal over abdominal hysterectomy when feasible | Does not compare vessel sealers against Masterson clamps; these results should not be used to endorse an energy device |
Sources: Tamussino, Li and Pickett.[6][7][8] For the newer 2024 vaginal pedicle-sealing systematic review, see Heaney: vessel sealing versus suture ligation.
The Cochrane review found that laparoscopic hysterectomy carried more urinary-tract injuries than abdominal hysterectomy (OR 2.16, 95% CI 1.19 to 3.93; moderate-certainty evidence).[8]
Open abdominal hysterectomy remains appropriate in selected circumstances. Uterine size or adhesions alone do not automatically require it; benign-disease route evidence also should not be extrapolated to all gynecologic cancers.[8]
Peripartum and complex cases
Pregnancy-related hysterectomy adds tissue edema, vascular engorgement and altered urinary-tract anatomy. Secure pedicle control is part of a coordinated hemorrhage strategy. The available operative review is largely based on retrospective series and expert-center techniques, and does not establish that one clamp or clamp-and-tie is invariably the fastest or safest method.[9]
Comparison with adjacent clamps
| Clamp | Typical approach | Note |
|---|---|---|
| Masterson | Abdominal | Straight and curved patterns; long, heavy jaws for broad pedicles |
| Heaney | Vaginal | Curved jaws follow the uterine contour in a deep, narrow field; Heaney-Ballantine has a double curve[3] |
| Rochester-Péan | Either | Long, heavy pedicle clamp with transverse serrations and no tip tooth |
| Kocher | Either | Interlocking tip teeth; used on fascia and tissue that is discarded |
Many teams keep both a Masterson and a Heaney on the tray when the route may change.
Limitations
- The clamp crushes tissue. This is acceptable on a pedicle that is to be ligated and on the specimen side; it is not acceptable for tissue that must stay viable.
- A curved or straight Masterson does not suit every route. A vaginal approach needs the Heaney geometry.
- Use is declining as vaginal, laparoscopic and robotic hysterectomy replace the open route in benign disease.[8]
The instrument remains on abdominal-hysterectomy trays and is taught in residency. It serves as backup hemostasis when an energy device is unavailable or fails, and in emergency hysterectomy when clamp-and-tie is the method at hand.
See also: Heaney, Rochester-Péan, Mayo Scissors.
References
1. Teleflex/Pilling. Masterson Hysterectomy Forceps, models 175059 and 175060. Manufacturer specifications.
2. Aspen Surgical/Symmetry. Clamp, Masterson Hysterectomy, Curved, 8½ in, part 37-1521. Manufacturer specifications.
3. Teleflex/Pilling. Surgical Instruments Catalog. Printed pages 257, 267–268: Masterson, Heaney and Heaney-Ballantine patterns. Manufacturer catalog.
4. Baggish MS. "Total and subtotal abdominal hysterectomy." Best Pract Res Clin Obstet Gynaecol. 2005;19(3):333–56. doi:10.1016/j.bpobgyn.2004.12.002
5. 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
6. Tamussino K, Afschar P, Reuss J, et al. "Electrosurgical bipolar vessel sealing for radical abdominal hysterectomy." Gynecol Oncol. 2005;96(2):320–2. doi:10.1016/j.ygyno.2004.09.021
7. Li L, Qie MR, Wang XL, et al. "BiClamp forceps was significantly superior to conventional suture ligation in radical abdominal hysterectomy: a retrospective cohort study in 391 cases." Arch Gynecol Obstet. 2012;286(2):457–63. doi:10.1007/s00404-012-2275-9
8. Pickett CM, Seeratan DD, Mol BWJ, et al. "Surgical approach to hysterectomy for benign gynaecological disease." Cochrane Database Syst Rev. 2023;8:CD003677. doi:10.1002/14651858.CD003677.pub6
9. 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