Tip-Up Fenestrated Grasper (da Vinci)
The Tip-Up Fenestrated Grasper is an 8 mm non-energized EndoWrist grasper with fenestrated jaws and an upward-angled tip. The scoop-like profile suits lifting and presenting tissue. It is not a validated lowest-force or inherently safer alternative to ProGrasp or Cadiere.
Design and Compatibility
The January 2026 US multiport catalog lists an 8 mm Tip-Up Fenestrated Grasper, part 470347, with 10 uses. Verify compatibility and use-life against the exact instrument and local instructions. This catalog entry does not establish an interchangeable SP version or a Force Feedback version.[1]
The upward-angled tip and fenestrated jaws suit exposures where the tissue must be lifted perpendicular to the shaft rather than pulled along it. Do not slide the instrument blindly beneath adherent bowel, mesh or an unseen structure.
Uses in Reconstruction
Surgeons commonly use a scoop-and-lift grasper in these settings. These are technical descriptions, not comparative evidence:
- Robotic sacrocolpopexy: sweeping the sigmoid mesentery cephalad to expose the promontory, and lifting the vaginal vault or uterine fundus for dissection.
- Ureteral reimplant, Boari flap and psoas hitch: lifting the bladder dome to expose the trigone and reimplant site without crushing the bladder wall.
- Fistula repair (VVF, ureterovaginal): lifting bladder and vaginal wall to define the tract.
- Mesh excision: scooping beneath bowel adherent to mesh during dissection.
- Renal surgery: lifting the kidney to expose the hilum.
| Instrument | Energy | Jaw geometry | Typical use |
|---|---|---|---|
| ProGrasp | None | Broad, toothed | Sustained traction along the shaft |
| Cadiere | None | Broad, fenestrated | General atraumatic grasping |
| Tip-Up Fenestrated | None | Fenestrated, upward-angled tip | Scoop-and-lift presentation |
| Fenestrated Bipolar | Bipolar | Broad, fenestrated | Retraction with coagulation |
Choosing a Grasper
Consider it alongside ProGrasp and Cadiere when planning exposure for pelvic or renal reconstruction. Selection depends on the accessible plane, tissue quality, desired direction of traction and arm configuration. Comparative clinical evidence does not identify one of these graspers as the safest for bladder, bowel, ureter or vaginal retraction.
- Identify the complete tissue purchase before closing the jaws or lifting.
- Keep both the tip and the tissue under traction visible. Reassess tension when the camera, table or other arms move.
- Avoid narrow, concentrated pressure on fragile structures. If the grasp slips, change the purchase or exposure rather than assuming that a stronger grasper will be safer.
- Release unnecessary sustained traction; a stationary retraction arm can still exert harmful force.
- Plan a separate means of hemostasis when needed. This instrument cannot coagulate, but clips, sutures and pressure remain alternatives to energy.
What the Bench Studies Do — and Do Not — Show
Mucksavage's 2011 bench study found the lowest grip force among the instruments tested in the double-fenestrated grasper (2.26 ± 0.15 N; highest was the Hem-o-lok clip applier at 39.92 ± 0.89 N), on da Vinci S, Si and Standard systems. That instrument designation cannot be relabeled as a measured value for today's Tip-Up Fenestrated Grasper, nor converted into a clinical safety threshold.[2]
Brown's bench experiment used parallel-occlusion laparoscopic jaws, not current robotic graspers. It found that fenestrations improve tissue retention when the contact-to-fenestration area ratio exceeds 1:0.4.[3] Lee's bench model showed that EndoWrist grip force varied 1.84 to 3.37 times with wrist posture for the same input force.[4] Together these suggest that lower grip force calls for care when sustained heavy traction is needed. Switch to a toothed grasper if the tissue slips. None of these studies shows that Tip-Up is always gentler or that another grasper is superior for a specific direction of pull.
Inspection and Limits
Follow the instrument's instructions for inspection, insertion, removal and reprocessing. Damaged jaws, unexpected resistance or abnormal movement require reassessment and appropriate replacement. Do not infer a current device-specific complication rate from historical case reports or reports lacking an exposure denominator.
The da Vinci family is no longer uniformly without force feedback: compatible da Vinci 5 instruments provide additional tissue-interaction feedback. That feature should not be assumed for this conventional Tip-Up model. Conventional da Vinci graspers give no haptic feedback, and the console grip input is not proportional to jaw output.[6] Visual tissue monitoring therefore remains necessary on every platform.[5]
References
1. Intuitive. Da Vinci Multiport Instrument and Accessory Catalog. BUS00143 V3 US, January 2026. Manufacturer catalog.
2. 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
3. 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
4. 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
5. Intuitive. Da Vinci instruments and Force Feedback technology. Current manufacturer descriptions, accessed September 12, 2026. Instrument portfolio; Force Feedback.
6. 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