Tenotomy Scissors (Stevens / Westcott / Jameson / Knapp / Castroviejo)
Small, fine scissors (~ 10–13 cm) originally designed for tendon-release work and now the default fine-dissection scissor for hypospadias, glansplasty, vulvar / introital, microsurgery-adjacent vasal, and pediatric reconstructive urology. The family spans several named variants; Stevens tenotomy scissors are the daily workhorse in RU/urogyn, with Westcott scissors reserved for the most delicate spring-action work and Castroviejo / micro tenotomy for microsurgical layers.[1][2]
Where Tenotomy Scissors Sit
Between iris scissors and Metzenbaum scissors on the fine-dissection axis:
| Scissor | Length | Tip | Best fit |
|---|---|---|---|
| Iris | 9–11 cm | Sharp pointed | Fine cutting in tight fields, skin / mucosa trim |
| Tenotomy (Stevens) | 10–13 cm | Blunt or semi-blunt | Fine sharp / blunt dissection of delicate planes |
| Westcott | ~ 11 cm | Ultra-fine, spring-action | Conjunctival / Tenon-equivalent planes; ophthalmic |
| Metzenbaum | 14–18 cm | Blunt | Workhorse pelvic plane dissection |
| Castroviejo / micro tenotomy | 8–12 cm spring-action | Ultra-fine | Microsurgical layers |
The defining feature of the standard Stevens tenotomy scissor is the short, slightly curved blade with a blunt tip that lets the surgeon both cut sharply and spread bluntly through fine planes — the same dual function as the Metzenbaum but at a smaller scale.
Reconstructive-Urology and Urogyn Uses
Stevens tenotomy — the daily RU workhorse
- Hypospadias and distal-urethral reconstruction — fine dissection of glanular wings, the urethral plate, and inner-prepuce flaps during TIP / TIPU / Mathieu / onlay-island-flap; the blunt tip is preferred over iris scissors for plane development on the glans where pointed tips would penetrate fragile glanular tissue.
- Glansplasty and glans-resurfacing — fine dissection on the glans and sub-glanular plane during partial glansectomy / glanuloplasty.
- Penile-shaft dissection — fine subcutaneous-dartos plane development during partial / radical circumcision revision, frenuloplasty, minor penile-skin reconstruction, and penile-disassembly procedures.
- Vulvar / introital fine work — labial-flap mobilization during labiaplasty, mucosal-flap dissection during posterior-vestibuloplasty, Foldès clitoral reconstruction, post-defibulation introital closure, and vestibulectomy.
- Pediatric urology — orchidopexy plane development, ureteral-reimplant dissection in the small field, pediatric pyeloplasty, and hydrocele / hernia-sac dissection.
- Microsurgery-adjacent vasal and cord work — adventitial trim and fine plane development during vasovasostomy and microsurgical varicocelectomy when a Castroviejo / dedicated microsurgical scissor is not on the field.
- Office and ED genital procedures — fine dissection during meatotomy / meatoplasty, foreskin-injury repair, urethral-caruncle excision, and condyloma excision.
- Flap-pedicle skeletonization in scaled-down fields — clearing fine adventitia from small perforator flaps and recipient vessels.
Westcott — ophthalmic-style spring-action delicate work
In RU / urogyn the spring-action Westcott is occasionally pulled onto a fine reconstructive tray for prolonged delicate work where the self-opening handle reduces hand fatigue:
- Microsurgical recipient-vessel preparation in LVA / VLNT / SCIP-LFT / CHASCIP genital lymphedema work — when a Castroviejo / dedicated microsurgical scissor is not preferred.
- Foldès clitoral reconstruction and FGM/C scar work — when prolonged fine dissection is anticipated.
Castroviejo / micro tenotomy — true microsurgical layers
- Vasovasostomy and vasoepididymostomy vasal-wall and epididymal-tubule work.
- Microsurgical penile / genital replantation vessel preparation.
- LVA and supermicrosurgical anastomotic openings.
Stevens vs Westcott — When to Pick Which
Both are tenotomy-family scissors but with different handle mechanisms and tip profiles:
| Feature | Stevens | Westcott |
|---|---|---|
| Handle | Standard ring | Spring-action (self-opening) |
| Tip | Blunt or semi-blunt | Ultra-fine (sharp or blunt) |
| Best fit | Fine plane dissection where blunt-tip safety matters | Prolonged delicate work where hand-fatigue reduction matters |
| RU/urogyn role | Hypospadias, glansplasty, labiaplasty, peri-vasal | Microsurgical recipient-vessel prep, Foldès / FGM/C fine work |
Technique
- Grip: ring-handle grip for Stevens; pencil / squeeze grip for Westcott — the spring-action design is built around the squeeze-and-release cadence.
- Cut + spread: the Stevens tenotomy is one of the few scissors equally good at sharp cutting and blunt spreading of delicate planes — insert closed, open against the plane, allow tissue to separate, then close to cut as needed.
- Single decisive cuts on fine tissue — stuttered tenotomy cuts on glanular or labial tissue produce ragged margins.
- Strict role segregation: never use on suture, drains, dressings, or mesh — switch to Mayo for those layers. Use on tissue only.
- Tip protection: store with tip guards; the fine tips bend easily and damaged tips deliver unpredictable trauma. Microsurgical variants (titanium spring-action) need ultrasonic cleaning and prefer ethylene-oxide sterilization to preserve blade integrity.[3][4]
Named Variants
| Variant | Defining feature | Daily RU/urogyn role |
|---|---|---|
| Stevens tenotomy | Ring handle, short curved blade, blunt tip, ~ 11.5 cm | Hypospadias / glansplasty / labiaplasty / Foldès / pediatric urology |
| Westcott | Spring-action, ultra-fine | Prolonged delicate work; microsurgical recipient-vessel prep |
| Jameson tenotomy | Curved, slightly heavier blades | Heavier ophthalmic / strabismus work; rarely on RU trays |
| Knapp tenotomy | Straight or curved, blunt | Specialty ophthalmic |
| Castroviejo tenotomy | Ultra-fine spring-action | Microsurgical RU layers (vasovasostomy, LVA, replantation)[4] |
Naming and Origin
"Tenotomy" derives from the Greek tenon (tendon) + tome (cutting). The scissors were developed in the 19th century as ophthalmic and orthopedic surgeons began performing precise tendon-release procedures (strabismus surgery, percutaneous Achilles tenotomy in clubfoot). Stevens tenotomy scissors — named for the American surgeon who popularized them — became the canonical fine-dissection scissor across ophthalmology, plastic surgery, ENT, and dermatologic surgery, and have been adopted into reconstructive urology for the same fine-plane work.[1][2]
See also: Iris Scissors, Metzenbaum Scissors, Mayo Scissors, Potts Scissors, Iris Forceps.
References
1. Christmas NJ, Gordon CD, Murray TG, et al. "Intraorbital implants after enucleation and their complications: a 10-year review." Arch Ophthalmol. 1998;116(9):1199–203. doi:10.1001/archopht.116.9.1199
2. Gandhi SA, Kampp JT. "Dermatologic surgical instruments: a history and review." Dermatol Surg. 2017;43(1):11–22. doi:10.1097/DSS.0000000000000911
3. Sood NN, Kumar H. "Microsurgical instruments and their care." Indian J Ophthalmol. 1989;37(2):67–8.
4. Chacha PB. "Operating microscope, microsurgical instruments and microsutures." Ann Acad Med Singap. 1979;8(4):371–81.