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ProGrasp Forceps (da Vinci)

Non-energized atraumatic EndoWrist grasping forceps — the standard fourth-arm retraction tool across nearly every robotic specialty. Broad jaws with a tooth-like surface grasp tissue securely for sustained surgeon-controlled retraction, without the energy capability of the Maryland / fenestrated / Force bipolar instruments. 8 mm on Si / Xi, 6 mm flexible on SP.[1][2][3]

Design​

  • Broad atraumatic tooth-pattern jaws — secure grip optimized for sustained retraction, not for dissection or hemostasis.
  • No electrical energy — purely mechanical; lowest-cost da Vinci grasping instrument.[4]
  • Full EndoWrist articulation (7 DoF).[5]
  • 8 mm S / Si / Xi; 6 mm flexible SP.[6][7]

Grip-force characteristics (important caveats)​

Mucksavage 2011 measured grip force across EndoWrist instruments — broad range from 2.26 ± 0.15 N (double-fenestrated) to 39.92 ± 0.89 N (Hem-o-lok clip applier).[8] Two operator-relevant patterns:

  • Nonlinear input-to-output — surgeon finger squeeze does not translate linearly to jaw closure force; the system also delivers no haptic feedback, so all tension estimation is visual.[9]
  • Posture-dependent force amplification — Lee 2015 showed grip force varies 1.84–3.37× with EndoWrist articulation angle for the same surgeon input — a hidden variable when grasping delicate ureter or NVB.[10]

Reconstructive-Urology and Urogyn Uses​

The ProGrasp is the fourth-arm retraction default across robotic urogyn / RU:

Robotic prostatectomy / reconstructive components​

  • Cephalad tension on the bladder dome during prostatic-vesical junction dissection.
  • Grasping the Foley catheter for traction during apical dissection and vesicourethral anastomosis.
  • The Ramirez 2016 three-instrument RARP technique (needle driver + ProGrasp + monopolar scissors only) reduces disposable instrument cost up to 40% by eliminating energy devices — a useful template when ProGrasp + Maryland substitute for the standard four-arm energy setup.[4]
  • Song 2023 "S.I.S." technique for post-RP continence — built around ProGrasp-managed bladder-neck traction.[11]

Robotic urogyn​

  • Robotic sacrocolpopexy — fourth-arm vaginal-vault elevation and sigmoid retraction while the Maryland develops the paravaginal tunnel and promontory exposure.
  • Robotic ureteral reimplant / Boari flap / psoas hitch — bladder-flap retraction during the anastomosis.
  • Robotic transvaginal-mesh excision — sustained mesh-edge retraction.
  • Robotic VVF / fistula repair — bladder and vaginal-wall retraction during fistula-tract dissection.

Robotic renal surgery (partial nephrectomy)​

  • Kidney retraction on stretch to expose the renal hilum.
  • Vascular-clamp manipulation — applying and removing bulldog clamps with the same fourth arm.[1]

Foregut and hepatobiliary surgery (cross-specialty)​

  • Liver-segment retraction (left lateral segment for hiatal / Nissen exposure) — replaces a bedside-assistant liver retractor.[12][13]
  • Hepatic mobilization and IVC dissection — Sood 2015 IVC level-3 thrombectomy series.[14]

ProGrasp vs Other da Vinci Graspers​

InstrumentEnergyTip profilePrimary roleTypical arm
ProGraspNoneBroad tooth-pattern atraumaticSustained retraction4th arm
CadiereNoneBroad fenestratedRetraction / general grasping3rd or 4th arm
Tip-Up FenestratedNoneHyperflex tip-upRetraction with elevation angle4th arm
Maryland bipolarBipolarFine curved MarylandDissection + discrete coagWorking arm
Fenestrated bipolarBipolarBroad fenestratedRetraction + diffuse coagWorking arm
Force bipolarBipolarStrong broadHighest-force countertraction + coagWorking arm

The ProGrasp's niche is non-energized sustained retraction at lowest cost — when energy is not needed, no reason to pay for it.

da Vinci SP Cannula-Distance Pearl​

On the SP, ProGrasp cannula placement matters: 10–15 cm from the incision allows full joggle-joint articulation. < 10 cm prevents full joint deployment; > 15 cm limits dexterity.[6]

Safety Considerations​

  • No haptic feedback + nonlinear grip control + posture-dependent force — together justify visual-only confirmation of tension and a conservative grip on delicate structures (ureter, NVB, vasa, sphincter complex).[8][9][10]
  • Mechanical malfunction is rare but reported — Park 2010 case of bolt loosening during robotic prostatectomy causing diminished function and difficult removal; inspect at instrument exchange.[15]
  • Non-energized: bleeding caught during retraction must be addressed with a separate energy device — plan instrument-arm choreography accordingly.

Limitations​

  • No energy — secondary instrument required for hemostasis.
  • Posture-dependent grip variance — a hidden variable in delicate tissue handling.
  • Lower precision than Maryland for fine dissection (not its job).

See also: Maryland Bipolar, Fenestrated Bipolar, Force Bipolar.

References​

1. Rogers CG, Laungani R, Bhandari A, et al. "Maximizing console surgeon independence during robot-assisted renal surgery by using the fourth arm and TilePro." J Endourol. 2009;23(1):115–21. doi:10.1089/end.2008.0416

2. Esposito MP, Ilbeigi P, Ahmed M, Lanteri V. "Use of fourth arm in da Vinci robot-assisted extraperitoneal laparoscopic prostatectomy: novel technique." Urology. 2005;66(3):649–52. doi:10.1016/j.urology.2005.03.061

3. Mohamed HE, Kandil E. "Robotic trans-axillary and retro-auricular thyroid surgery." J Surg Oncol. 2015;112(3):243–9. doi:10.1002/jso.23955

4. Ramirez D, Ganesan V, Nelson RJ, Haber GP. "Reducing costs for robotic radical prostatectomy: three-instrument technique." Urology. 2016;95:213–5. doi:10.1016/j.urology.2016.03.067

5. Jung M, Morel P, Buehler L, Buchs NC, Hagen ME. "Robotic general surgery: current practice, evidence, and perspective." Langenbecks Arch Surg. 2015;400(3):283–92. doi:10.1007/s00423-015-1278-y

6. 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

7. Noel JE, Lee MC, Tam K, et al. "Retroauricular thyroidectomy with a single-arm robotic surgical system: preclinical cadaveric study." Head Neck. 2020;42(12):3663–9. doi:10.1002/hed.26436

8. Mucksavage P, Kerbl DC, Pick DL, et al. "Differences in grip forces among various robotic instruments and da Vinci surgical platforms." J Endourol. 2011;25(3):523–8. doi:10.1089/end.2010.0306

9. Johnson PJ, Schmidt DE, Duvvuri U. "Output control of da Vinci Surgical System's surgical graspers." J Surg Res. 2014;186(1):56–62. doi:10.1016/j.jss.2013.07.032

10. Lee C, Park YH, Yoon C, et al. "A grip force model for the da Vinci end-effector to predict a compensation force." Med Biol Eng Comput. 2015;53(3):253–61. doi:10.1007/s11517-014-1230-2

11. Song QX, Li J, Shen K, et al. "The application of 'S.I.S' technique improves long-term continence after robotic radical prostatectomy." Neurourol Urodyn. 2023;42(3):650–61. doi:10.1002/nau.25131

12. Tolboom RC, Broeders IA, Draaisma WA. "Robot-assisted laparoscopic hiatal hernia and antireflux surgery." J Surg Oncol. 2015;112(3):266–70. doi:10.1002/jso.23912

13. Newlin ME, Mikami DJ, Melvin SW. "Initial experience with the four-arm computer-enhanced telesurgery device in foregut surgery." J Laparoendosc Adv Surg Tech A. 2004;14(3):121–4. doi:10.1089/1092642041255397

14. Sood A, Jeong W, Barod R, et al. "Robot-assisted hepatic mobilization and control of suprahepatic infradiaphragmatic inferior vena cava for level 3 vena caval thrombectomy: an IDEAL stage 0 study." J Surg Oncol. 2015;112(7):741–5. doi:10.1002/jso.23980

15. Park SY, Ahn JJ, Jeong W, Ham WS, Rha KH. "A unique instrumental malfunction during robotic prostatectomy." Yonsei Med J. 2010;51(1):148–50. doi:10.3349/ymj.2010.51.1.148