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Fenestrated Bipolar Forceps (da Vinci)

EndoWrist articulating bipolar forceps with broad flat fenestrated (windowed) jaws — the complement to the Maryland bipolar, traded toward secure tissue grasping, broad retraction, and diffuse surface-bleed control rather than fine-tip dissection. Available on da Vinci SP (6 mm) and Xi (5 mm / 8 mm) with full EndoWrist 7-DoF articulation. In urogyn / reconstructive-urology robotics, the typical setup is Maryland bipolar in one arm + fenestrated bipolar in another for retraction + monopolar curved scissors in the right hand.[1][2][3]

Design​

  • Broad flat-tipped jaws with fenestrations — windows in the jaw surface increase the force needed to pull tissue free, improving grip security for sustained retraction (Brown 2014 bench data).[4]
  • Flat backside provides a wider contact surface for tamponading diffuse surface bleeding — the principal hemostasis advantage over the fine-tipped Maryland.[1]
  • Bipolar energy with the same optional auto-stop function (terminates at maximum impedance).[1]
  • 6 mm SP / 5 mm / 8 mm Xi; 7 degrees of freedom.[2][3]
  • Common settings — 3 or 4 for both mono and bipolar; default cut / forced coag (same as the Maryland workflow).[1]

Maryland vs Fenestrated Bipolar — The Complementary Pair​

FeatureMaryland bipolarFenestrated bipolar
Tip profileFine curved Maryland tipBroad flat fenestrated
Primary rolePrecise dissection, pass-around vessels / ureter, vessel coagulationGrasping, retraction, diffuse surface-bleed control
HemostasisDiscrete vessel coagulation (curved-face contact)Diffuse surface tamponade (flat-back contact)
Best useRight-angle dissection, NVB sparing, fine planesSustained tissue retraction; broad pedicle compression
Auto-stopAvailableAvailable

Reconstructive-Urology and Urogyn Uses​

  • Robotic sacrocolpopexy — broad atraumatic retraction of the sigmoid mesentery, broad-ligament structures, and posterior vagina while the Maryland develops the paravaginal tunnel.
  • Robotic-assisted ureteral reimplantation / Boari flap / psoas hitch — secure ureteral / bladder-flap retraction; broad-tip handling of the bladder dome.
  • Robotic transvaginal-mesh excision — sustained traction on the mesh edge while the Maryland develops the dissection plane.
  • Robotic VVF / fistula repair — broad retraction of bladder / vaginal walls.
  • Robotic radical prostatectomy reconstructive components — bladder-neck and DVC retraction during posterior reconstruction and VUA.
  • Robotic radical nephroureterectomy (Argun 2016 Xi description) — tissue manipulation and hemostasis during both the nephrectomy and distal-ureterectomy phases.[3]
  • Robotic pelvic / para-aortic lymphadenectomy in gynecologic-oncology RU/urogyn cross-over — standard left-hand instrument paired with right-hand monopolar scissors (Wisner 2015).[5]

Double-Bipolar Method — A Useful Paradigm​

The "double bipolar" approach deploys both Maryland and fenestrated bipolar simultaneously — bimanual dissection-plus-retraction-plus-hemostasis without instrument exchanges. The technique has been adopted across:

  • Robotic hysterectomy — Ochi 2024 "double-bipolar method" reduces instrument changes and cost.[6]
  • Robotic total mesorectal excision — Katsuno 2022 DBM significantly shorter console time vs single-bipolar.[7]
  • Robotic liver resection — Chiarella 2025 MAMBA (Moisture-Assisted Multiple BipolAr) technique uses Maryland + fenestrated bipolar with clamp-crush parenchymal transection; propensity-matched study (n = 921) — no difference in OR time, EBL, conversion, or complications vs the hybrid robo-lap approach.[8]
  • Transoral robotic thyroidectomy — Oh 2026 double-bipolar vs ultrasonic energy: lobectomy 131.7 vs 174.7 min; total 185.6 vs 217.4 min, both p < 0.05.[9]

The cross-specialty signal translates to robotic urogyn — double-bipolar setups for sacrocolpopexy / complex hysterectomy / fistula repair can reduce instrument-exchange time in cases with frequent dissection-plus-retraction handoffs.

Limitations​

  • Less precise than Maryland for fine dissection — broader tips trade precision for grip.
  • Vessel-size ceiling — same as Maryland; clip larger pedicles rather than rely on bipolar.
  • Thermal spread — bipolar profile similar to other da Vinci bipolar instruments; respect 2–3 mm working margin near nerves (NVB, obturator, dorsal nerve of clitoris).
  • Broad-tip footprint can crowd narrow operative corridors — switch to Maryland or ProGrasp in deep pelvic spaces.

See also: Maryland Bipolar Forceps, Gerald Bipolar Forceps, Electrosurgical Pencil, Bovie Tips, Mixter Right-Angle Clamp.

References​

1. Oberhelman N, Bruening J, Jackson RS, et al. "Comparison of da Vinci Single Port vs Si systems for transoral robotic-assisted surgery: a review with technical insights." JAMA Otolaryngol Head Neck Surg. 2024;150(2):165–71. doi:10.1001/jamaoto.2023.3994

2. Kim TK, Seo M, Park SH, et al. "Feasibility of robotic thyroidectomy via hairline incision using da Vinci single port system: initial experience with 40 consecutive cases." Head Neck. 2022;44(10):2197–205. doi:10.1002/hed.27134

3. Argun OB, Mourmouris P, Tufek I, et al. "Radical nephroureterectomy without patient or port repositioning using the da Vinci Xi robotic system: initial experience." Urology. 2016;92:136–9. doi:10.1016/j.urology.2016.02.047

4. Brown AW, Brown SI, McLean D, Wang Z, Cuschieri A. "Impact of fenestrations and surface profiling on the holding of tissue by parallel occlusion laparoscopic graspers." Surg Endosc. 2014;28(4):1277–83. doi:10.1007/s00464-013-3323-7

5. Wisner KP, Gupta S, Ahmad S, Holloway RW. "Indications and techniques for robotic pelvic and para-aortic lymphadenectomy in gynecologic oncology." J Surg Oncol. 2015;112(7):782–9. doi:10.1002/jso.24005

6. Ochi Y, Andou M, Taniguchi R, et al. "Robot-assisted hysterectomy using the double-bipolar method." J Minim Invasive Gynecol. 2024;31(8):640. doi:10.1016/j.jmig.2024.03.013

7. Katsuno H, Hanai T, Endo T, Morise Z, Uyama I. "The double bipolar method for robotic total mesorectal excision in patients with rectal cancer." Surg Today. 2022;52(6):978–85. doi:10.1007/s00595-021-02418-y

8. Chiarella LL, Muttillo EM, Fichtner-Feigl S, et al. "MAMBA (moisture-assisted multiple bipolar) technique vs robo-lap approach in robotic liver resection. Is it possible a full robotic approach for parenchymal transection? A propensity score matching analysis." Surg Endosc. 2025;39(4):2721–8. doi:10.1007/s00464-025-11622-7

9. Oh MY, AlMadan M, Park D, et al. "Comparative use of double bipolar forceps versus ultrasound energy device in transoral robotic thyroidectomy." Head Neck. 2026. doi:10.1002/hed.70280