Rochester-Péan Clamp
Large, heavy ratcheted ring-handled hemostat with full-length transverse serrations — the long Mayo-Clinic-refined variant of the Péan. Same jaw pattern as the standard Péan but longer (16–25 cm) and built for deeper surgical fields and larger pedicles. The workhorse "long heavy clamp" on open RU/urogyn pelvic trays for medium-to-large vessel and pedicle control.[1][2]
Design
- Jaws: transverse serrations the entire length of the jaw; no teeth at the tip (the absence of a tip tooth distinguishes it from the Kocher, and the transverse pattern distinguishes it from the Rochester-Carmalt's longitudinal serrations).
- Length: 16–25 cm (6.25–10 in) — significantly longer than the Kelly (~ 14 cm) or Halsted mosquito (~ 12.5 cm).
- Profile: heavy-gauge stainless steel jaws and shanks for robust crushing forces.
- Mechanism: ring-handled box lock with a multi-position ratchet.
- Configurations: straight and curved.
What Distinguishes the Rochester-Péan
The instrument family is dense and routinely confused. The simplest decision tree:
| Clamp | Serrations | Tip tooth | Length |
|---|---|---|---|
| Rochester-Péan | Full jaw, transverse | No | 16–25 cm |
| Péan (standard) | Full jaw, transverse | No | 14–18 cm |
| Rochester-Carmalt | Full jaw, longitudinal with cross-hatch at tip | No | 16–20 cm |
| Kocher / Ochsner | Full jaw, transverse | Yes (1×2) | 14–24 cm |
| Kelly | Distal half, transverse | No | ~ 14 cm |
| Crile | Full jaw, transverse, finer | No | ~ 14 cm |
| Halsted mosquito | Full jaw, fine | No | ~ 12.5 cm |
In bench-side parlance the Rochester-Péan is often just called a "Péan" or "Rochester" — the named variant a particular institution stocks is usually whichever one was inherited from training. The defining features are full-length transverse serrations on a long heavy jaw with no tip tooth.
Reconstructive-Urology and Urogyn Uses
The Rochester-Péan is the right clamp whenever the pedicle is large, deep, or both, and a tip tooth would over-crush or puncture:
- Pedicle clamping prior to ligation at depth — broad-ligament, IP, and uterine pedicles during adjunctive hysterectomy; cardinal ligament, uterosacral, and round-ligament pedicles during open POP / fistula / sacrocolpopexy work; spermatic-cord pedicles during open / salvage orchiectomy.
- Medium-to-large vessel control in deep pelvic fields where a Kelly is too short and a Schnidt curve is wrong for the angle — branches of the dorsal venous complex, internal iliac branches, and obturator tributaries during deep pelvic dissection.
- Mesenteric and omental pedicles during open urinary diversion (ileal conduit, neobladder, Indiana / Miami pouch) and augmentation cystoplasty — clamping mesenteric vessels before division as part of segment isolation.
- Open VVF / RVF / RUF repair — peri-fistula pedicle and omental / gracilis pedicle handling for interposition flaps.
- Classic clamp-clamp-cut-tie sequence: Rochester-Péan above and below the pedicle, cut between, replace the proximal clamp with a suture ligature — the canonical pedicle-management technique.
- Specimen handling — partial cystectomy / partial nephrectomy specimens and large excised tissue.
- Blunt dissection through tougher tissue planes using the closed tip — when a Kelly's lighter jaws would deflect.
Not appropriate for: bowel, ureter, vessels intended for anastomosis, or any layer planned to remain in situ — full-length serrations are crushing. Switch to Babcock or DeBakey. For fascia or pedicles requiring an interlocking tip tooth, switch to Kocher.
Technique
- Grip: thumb-and-ring-finger through the rings, index along the shank.
- Tip-first grasp: position the curved tip at the pedicle, close to the first or second ratchet, check for purchase, then advance compression as needed.
- Paired-clamp pedicle ligation: place a Rochester-Péan above and below the pedicle, divide between, then replace the proximal clamp with a transfixion suture and tie — the long heavy clamp holds the pedicle in place for the tie even at depth.
- Layered alternation: pair with a Kelly or Crile for smaller bleeders encountered during the same dissection — Rochester-Péan handles the named pedicles, Kelly / Crile handle the parenchymal bleeders along the way.
Historical Context
The instrument descends from two lines:
- Jules-Émile Péan (1830–1898) developed the first practical locking hemostatic forceps in 1860s–70s Paris. Before Péan, hemostasis depended on ligatures, cautery, and digital pressure; the introduction of the ratcheted locking clamp made major surgery survivable in the pre-electrocautery era.[1][2]
- Mayo Clinic, Rochester, Minnesota refined Péan's design into a longer, heavier instrument suited for deeper abdominal and pelvic work, giving the variant its dual eponym.
The hemostatic-forceps lineage in turn descends from antiquity (Celsus, 1st century AD), through Ambroise Paré (1582) and Lorenz Heister (1743), culminating in the modern Péan / Kelly / Crile / Halsted / Kocher families that anchor every operating-room tray.[1]
See also: Péan, Kelly, Crile, Kocher, Schnidt (Tonsil), Halsted Mosquito.
References
1. 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
2. El-Sedfy A, Chamberlain RS. "Surgeons and their tools: a history of surgical instruments and their innovators. Part V: pass me the hemostat / clamp." Am Surg. 2015;81(3):232–8.