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ProGrasp Forceps (da Vinci)

ProGrasp is a non-energized EndoWrist grasper with broad tooth-pattern jaws. It is the usual fourth-arm retraction instrument for sustained, surgeon-controlled retraction. It cannot dissect or coagulate; the Maryland, fenestrated and force bipolar instruments do. Neither its jaw design nor the term atraumatic guarantees injury-free handling.

Design and Platform Compatibility​

The January 2026 US multiport catalog lists the 8 mm ProGrasp, part 471093, with 18 uses. A separate Force Feedback ProGrasp is offered for da Vinci 5. The June 2026 SP catalog lists other graspers, including Cadiere; it does not list a 6 mm SP ProGrasp. Match the instrument, software and accessories to the actual system and its instructions.[1][2]

Conventional instruments provide visual rather than direct tactile information. Compatible da Vinci 5 Force Feedback instruments add resistance related to tissue interaction; this does not reproduce every aspect of fingertip sensation or make excessive jaw compression safe.[3]

Reconstructive-Urology and Urogyn Uses​

Typical roles for the fourth arm:

  • Sacrocolpopexy: elevating the vaginal vault and retracting the sigmoid while the working arms expose the promontory and develop the vaginal tunnel.
  • Ureteral reimplant, Boari flap and psoas hitch: retracting the bladder flap during the anastomosis.
  • Mesh excision and fistula repair: sustained mesh-edge, bladder-wall and vaginal-wall retraction during tract dissection.
  • Pelvic dissection: cephalad traction on the bladder dome, or traction on the Foley catheter during apical dissection and vesicourethral anastomosis.
  • Partial nephrectomy: kidney retraction to expose the hilum, and applying or removing bulldog clamps.

Older fourth-arm renal and prostatectomy reports describe greater console control of retraction, but do not establish ProGrasp as the best grasper for every structure or operation.[4][5]

Select the grasping site and traction vector according to the tissue and intended plane. Prefer a broad, visible area that tolerates the required traction; avoid using the ureter, a vascular pedicle or fragile bowel as a convenient traction handle. Reassess exposure and tissue tension after moving the camera, working arms or patient table. A retraction arm can continue loading tissue even when attention shifts elsewhere.

InstrumentPractical distinction
ProGraspNon-energized grasping and sustained retraction
CadiereBroad fenestrated grasping profile
Tip-Up FenestratedDifferent jaw geometry for selected presentation and retraction tasks
Fenestrated bipolarGrasping with bipolar coagulation capability
Force bipolarSelectable grip modes and bipolar capability, depending on model

This is a functional comparison, not a ranking of tissue safety or a requirement to assign a particular arm.

Grip Force — What the Experiments Establish​

Mucksavage's 2011 bench study tested instruments on Standard, S and Si systems. Measured forces ranged from 2.26 N for a double-fenestrated grasper to 39.92 N for a clip applier. These are experimental measurements from specified older instruments, not clinical safe-grip limits or values for current ProGrasp and SP instruments.[6]

Other bench work demonstrated nonlinear control response.[7] Lee's 2015 measurements showed that, for the same surgeon input, grip force varied from 1.84 to 3.37 times across EndoWrist postures, which matters when holding a ureter or nerve.[8] These findings support careful observation of tissue deformation; their numerical ratios should not be generalized to every EndoWrist instrument or current Force Feedback system.

Workflow and Safety​

  • Maintain a clear view of both jaws and the tissue being held. Reduce or release traction when tissue blanches, tears, slips or distorts the operative plane; reassess the cause before applying more force.
  • Non-energized does not mean incapable of injury. Compression, traction and an unrecognized mechanical fault remain relevant.
  • Inspect the instrument according to its instructions, including before insertion and after removal. Published malfunction reports establish the need for a retrieval or backup plan, not a current device-specific failure rate.[9]
  • Plan hemostasis separately: pressure, clips, suturing or an appropriate energy device may be needed. Energy is not mandatory simply because this grasper cannot coagulate.
  • Use-life and cost are model- and contract-dependent. Ramirez's 2016 single-center RARP technique used only a needle driver, ProGrasp and monopolar scissors; the authors estimated that omitting high-cost energy instruments could reduce operative costs by up to 40% and using one needle driver instead of two by another 12%. Those historical savings do not establish today's cheapest grasper or justify compromising exposure.[10]

For SP access and docking, see Single-Port Robotics. A cannula-distance recommendation from a transoral or cadaveric neck approach should not become a universal pelvic docking rule.

References​

1. Intuitive. Da Vinci Multiport Instrument and Accessory Catalog. BUS00143 V3 US, January 2026. Manufacturer catalog.

2. Intuitive. Da Vinci SP Instrument and Accessory Catalog. MAT03926US v4, June 2026. Manufacturer catalog.

3. Intuitive. Da Vinci instruments and Force Feedback technology. Current manufacturer descriptions, accessed September 12, 2026. Instrument portfolio; Force Feedback.

4. 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

5. 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

6. 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

7. 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

8. 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

9. 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

10. 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