Péan Clamp
A ring-handled, ratcheted hemostat with transverse jaw serrations, usually extending along the jaw. Straight, curved and longer patterns are sold under Péan and related names. Inspect the actual model rather than assuming that every Péan is larger or produces more force than every Kelly or Crile.[1][2]
Compared with the Kelly, the Péan is chosen for a larger pedicle that needs a longer bite. Unlike the Kocher, it has no interlocking tip tooth.
Recognition
| Pattern | Useful identifying feature |
|---|---|
| Péan / Rochester-Péan | Full transverse jaw serrations in the familiar patterns; no interlocking tip tooth |
| Kelly | Distal-half transverse serrations in the usual pattern |
| Crile | Full transverse serrations; compare the actual jaw dimensions with the Péan |
| Kocher / Ochsner | The familiar open pattern adds interlocking 1×2 tip teeth |
Serration extent helps identify a clamp. Full-jaw serrations spread the grip along the whole jaw, which suits a larger pedicle that must be held without rotating before it is tied. A Kelly, with distal-half serrations, is used for moderate vessels and blunt dissection. Serration extent does not prove uniform compression or a predictable injury ranking.
| Clamp | Serrations | Tip tooth | Usual fit |
|---|---|---|---|
| Péan | Full jaw, transverse | No | Larger pedicles |
| Kelly | Distal half, transverse | No | Moderate vessels, blunt dissection |
| Crile | Full jaw, transverse | No | Small to moderate vessels |
| Halsted mosquito | Fine, narrow profile | No | Fine vessels |
| Mixter | Variable | No | Passing a tie around a vessel or pedicle |
| Kocher | Full jaw | Yes (1×2) | Fascia, dense scar, pedicles for ligation |
Length is model-specific. For example, Aesculap BH837R is a curved 220 mm Péan hemostatic forceps; the Rochester-Péan family includes both ordinary and extended-length instruments. There is no universal short-Péan/long-Rochester boundary.[1][2]
Role in reconstruction
A Péan can secure an identified bleeding point or a selected pedicle intended for ligation. Hemostatic compression and temporary vascular occlusion are different tasks: preserved vessels need appropriate vascular clamps.[3] Typical uses in open reconstructive work include:
- Broad-ligament, infundibulopelvic and uterine pedicles during hysterectomy performed with pelvic reconstruction, and adnexal pedicles during open prolapse or fistula repair.
- Spermatic-cord branches during open or salvage orchiectomy.
- A vessel that a Kelly bite is too small to control.
- A pendant clamp on a cut tissue edge in a deep pelvic field, where the firm grip lets it hold the edge for traction.
For smaller or more delicate work, use a Kelly or mosquito. For fascia, dense scar or a pedicle that needs an interlocking tip tooth, use a Kocher.
For pelvic pedicle division, use the procedure's exposure and ligation plan. A heavier clamp is not automatically the answer to slippage; reassess jaw fit, tissue bulk, traction and what lies inside the bite. For hysterectomy-specific steps, see Heaney clamp and Vaginal hysterectomy.
Handling principles
- Identify and expose the target. Exclude surrounding ureter, bowel, nerve and vessels needed for reconstruction.
- Seat the intended tissue within the jaws. Avoid an oversized bite, crowding tissue into the hinge or relying on tip-only purchase for every pedicle.
- Use controlled closure and traction. Position the tip at the pedicle, close to the first or second ratchet and check purchase before closing further. Ratchet clicks do not specify safe tissue pressure. Some surgeons place a Péan above and a Kelly below the pedicle for clamp-clamp-cut-tie; this is a habit, not a general operative rule.
- Secure definitive hemostasis and inspect after controlled release. Clamp placement and ligature or transfixion technique depend on the pedicle and operation.
A ligated stump can remain in the patient after intentional crush-and-ligate control. The important distinction is tissue intended for ligation versus tissue whose function or blood supply must be preserved. Do not use the crushing jaws as an atraumatic grasper for viable bowel, ureter, graft or flap tissue, or as an occlusion clamp across a vessel intended for anastomosis.
Name
The name refers to Jules-Émile Péan (1830–1898), a Parisian surgeon associated with hemostatic forceps. Several inventors contributed to their evolution. The name does not establish a single historical prototype or a clinical superiority claim.[3][4] Péan is also widely credited with the first total shoulder replacement, in 1893, which he based on the work of Themistocles Gluck.[5] Reviews of hemostatic-forceps history trace a line from ancient ligature forceps through the locking clamps of the nineteenth century to modern atraumatic vascular clamps.[4]
See also: Kelly, Kocher, Rochester-Péan, Allis, Babcock.
References
1. B. Braun/Aesculap. Péan hemostatic forceps, curved, 220 mm, BH837R. Manufacturer listing.
2. Teleflex/Pilling. Surgical Instruments Catalog. Printed pages 70–71 and 256: Rochester-Péan and related patterns. Manufacturer catalog.
3. Crumplin MKH. "Vascular forceps and clamps." Br J Surg. 2023;110(7):753–756. doi:10.1093/bjs/znac380.
4. Sachs M, Auth M, Encke A. "Historical development of surgical instruments exemplified by hemostatic forceps." World J Surg. 1998;22(5):499–504. doi:10.1007/s002689900424.
5. Bankes MJ, Emery RJ. "Pioneers of shoulder replacement: Themistocles Gluck and Jules Emile Péan." J Shoulder Elbow Surg. 1995;4(4):259–262. doi:10.1016/s1058-2746(05)80018-7.