Ring (Sponge / Foerster / Rampley) Forceps

Ratcheted, ring-handled sponge-holding forceps with fenestrated jaws are used to hold gauze or a counted Kittner peanut for preparation, packing, swabbing, focal pressure, and selected blunt dissection. Foerster and Rampley are cataloged as distinct sponge-forceps patterns; the names are not identical, and the actual model should be checked.

Design

• Tips: fenestrated oval jaws; the working surfaces may be smooth or serrated. For example, Sklar Foerster 87-2095 is straight, smooth, and 9½ in (241 mm), while its catalog also lists serrated and curved versions. Manufacturer product page.
• Mechanism: ring-handled box lock with a ratchet; holds the sponge or tissue without sustained hand pressure.
• Length: model dependent. Integra's Foerster catalog includes 7-, 9½-, and 14-in straight serrated models; STERIS catalogs Rampley 180- and 240-mm models. Straight and curved Foerster configurations are available. Integra catalog; STERIS catalog.
• Material: surgical-grade stainless steel; reusable autoclavable.

The fenestrated jaws can hold a sponge over a broader area than a pointed tip. This does not establish that direct tissue grasp with ring forceps is atraumatic or equivalent to a Babcock clamp.

Reconstructive-Urology and Urogyn Uses

Vaginal preparation and skin prep

• Sterile preparation of the perineum, vulva, or vagina when indicated for the procedure. A sponge can be held in the jaws, but the antiseptic formulation, mucosal suitability, application sequence, and drying time must follow the product instructions and local protocol. The ACOG perioperative guidance discusses vaginal povidone-iodine and selected chlorhexidine formulations; it does not make every skin-prep formulation interchangeable for vaginal use.
• Operative-field prep of the scrotal, suprapubic, perineal, and inguinal skin.

Vaginal packing placement and removal

• Insertion of vaginal packing, when selected after vaginal prolapse or fistula surgery, using the forceps to advance and position packing without dislodging the previous portion. A transperineal posterior urethroplasty does not itself require vaginal packing.
• Removal of vaginal packing at the planned time under the operative team's protocol; postoperative day 1 is not a universal removal schedule. Confirm the documented packing and account for its complete removal.

Sponge-stick blunt dissection

• A folded surgical sponge gripped in the ring jaws becomes a sponge stick, which is used for blunt-plane development in deep pelvic dissection (retropubic space, recto-vaginal plane, vesico-vaginal plane), open BNR, augmentation, diversion, sacrocolpopexy, and posterior urethroplasty.
• A larger sponge may contact a broader area than a Kittner, but neither the force distribution nor a faster or safer plane-development advantage has been established as a universal comparison.

Cervical / vaginal-cuff stabilization

• Cervical or cuff handling may be considered with an appropriate model when its grip is adequate and the tissue is suitable. Do not assume a ring forceps is a substitute for a tenaculum when sustained cervical traction is required.
• The Andrews 2023 randomized trial compared an Allis clamp with a single-tooth tenaculum during IUD placement; it did not test ring forceps. Its bleeding result cannot establish ring-forceps superiority, less pain, or an “atraumatic” cervical grasp.

Kittner-handle and peanut grasping

• One possible handle for a securely loaded, counted Kittner / peanut dissector. Match the jaw to the sponge and verify secure retention without excessive compression; a universal first-ratchet setting and injury-free dissection are not established.

Foreign-body retrieval

• Retained vaginal foreign bodies, vaginal-cavity stones, post-pessary granuloma debridement, and post-fistula packing retrieval.

Other

• Drape securement in some institutional traditions.
• Wound-cavity inspection with a sponge-tipped ring forceps as an absorbent probe.

Technique

• Grip: thumb-and-ring-finger through the rings, index along the shank.
• Sponge or peanut loading. Seat the counted sponge symmetrically and securely in both jaws. Use only enough ratchet closure to retain it; the correct setting depends on the instrument and sponge, not a universal first/second/third-ratchet rule.
• Vaginal packing. Lead the first turn of packing to the apex, release, regrasp the next exposed loop and advance; repeat until the apex is filled and the packing is at the introitus.
• Blunt dissection. In the sponge-stick technique, push along the plane, opening only enough to apply tension; do not "spread to dissect" the way one would with a Kelly. The sponge does the work, and the jaws only hold it.
• Cervical grasp, if chosen: use a controlled bite with adequate but not excessive traction, and reassess for slippage or tissue injury. There is no validated ring-forceps ratchet setting for every cervix.

Distinctions from Adjacent Instruments

Instrument	Tip	Best fit
Sponge-holding forceps (Foerster or Rampley pattern)	Fenestrated jaws, model-specific surface	Prep, packing, swabbing, sponge-stick dissection; selected tissue handling requires judgment
Allis clamp	Short interlocking teeth	Skin, fascia, vaginal cuff, resected tissue
Babcock clamp	Smooth fenestrated	Bowel, ureter, hollow viscera
Single-tooth tenaculum	Pointed grasp	Cervical traction; the Allis comparison does not quantify ring-forceps bleeding
Singley thumb forceps	Fenestrated thumb forceps, no ratchet	Bowel / peritoneum, handheld
Kittner dissector	Peanut-shaped cotton/gauze sponge	Held in a ring forceps for soft blunt dissection

Naming

Foerster and Rampley appear as separate product families in surgical catalogs. “Ring forceps” or “sponge forceps” may be used loosely in the operating room, but the actual jaw, curvature, length, and manufacturer's instructions determine what is at hand.

See also: Kittner Dissector, Allis Clamp, Babcock Clamp, Singley.