Tenotomy Scissors (Stevens / Westcott / Jameson / Knapp / Castroviejo)
Fine scissors for delicate cutting and dissection, available in different blade, tip and handle patterns. Stevens tenotomy models are used in several surgical specialties; they may be useful in a suitably exposed GU field, but no reviewed source establishes a universal reconstructive-urology tray default. Westcott and Castroviejo patterns offer different fine-tool geometries and are not a mandatory escalation ladder.[1][5][6]
Where Tenotomy Scissors Sit
Between iris scissors and Metzenbaum scissors on the fine-dissection axis:
| Scissor | Length | Tip | Best fit |
|---|---|---|---|
| Iris | Model-specific | Sharp/sharp, sharp/blunt or blunt/blunt | Fine exposed tissue, by model |
| Tenotomy (Stevens) | 11–11.5 cm in checked models | Pointed or blunt; straight or curved | Fine tissue dissection or suture cutting when permitted by the model IFU |
| Westcott | 11.4 cm in one Aspen model | Check chosen tip; spring-action pattern | Ophthalmic delicate work; selected other fine work |
| Metzenbaum | Model-specific | Model-specific | Larger soft-tissue planes, by model |
| Castroviejo / micro | Model-specific | Ultra-fine variants | Microsurgical layers when actual scale fits |
Stevens-pattern blades can be straight or curved, pointed or blunt. For example, FCI lists all four combinations, while DTR's named single-use Stevens models permit delicate tissue dissection and tissue or suture cutting. Spreading in a fine tissue plane is an instrument-and-tissue judgment, not a safety property guaranteed by the name.[1][5]
Reconstructive-Urology and Urogyn Uses
Stevens tenotomy — selected fine GU work
- Hypospadias and distal-urethral reconstruction. Selected fine dissection of glanular wings, urethral plate and inner-prepuce flaps during TIP / TIPU / Mathieu / onlay-island-flap; choose the actual tip and dissection plane under direct vision rather than assuming a Stevens is blunt or safer than every Iris model.
- 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 a spring-action Westcott may be selected for a fine reconstructive task if its scale and tip are appropriate; the spring mechanism does not itself demonstrate lower fatigue in those operations. An Aspen Westcott model is listed as reusable for ophthalmic surgery, with a 4½-in length.[7]
- 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 | Pointed or blunt, by model | Model-specific fine tip |
| Best fit | Fine tissue work when selected tip/edge suits the plane | Fine work where spring-handle control suits the operator |
| RU/urogyn role | Possible selected hypospadias, glans, labial or peri-vasal work | Possible selected reconstruction; no routine-use evidence from ophthalmic catalog |
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 and 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.
- Controlled cuts under direct vision protect delicate glanular or labial edges; use as many small cuts as exposure and tissue demand rather than an obligatory single cut.
- Task and IFU: a dedicated tissue pair may protect a reusable fine edge, but DTR's named single-use Stevens models explicitly permit tissue and/or suture cutting. Choose another instrument for heavy material unless the actual model's instructions allow the task.[5]
- Care and sterility: protect fine tips from damage and follow the specific model's instructions. DTR's named models are supplied sterile, ethylene-oxide-sterilized and must not be reused or resterilized. FCI's Stevens models are reusable; Aspen's general reusable-instrument IFU recommends steam unless a device-specific instruction overrides it. The 1989 microsurgery article's EtO preference is historical and cannot be generalized to current reusable or single-use models.[3][5][7]
Named Variants
| Variant | Example geometry | Possible role when scale and exposure suit |
|---|---|---|
| Stevens tenotomy | Straight/curved and pointed/blunt variants; 11–11.5 cm examples | Selected fine GU work when model and exposure suit |
| 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" denotes tendon cutting. Stevens-pattern instruments retain an ophthalmic tenotomy association and are cataloged in multiple straight or curved and pointed or blunt forms.[1][6] General dermatologic-instrument history offers context, but the identity of a specific Stevens eponym and claims that the model became the canonical GU fine-dissection scissor require better primary historical and operative sources.[2]
See also: Iris Scissors, Metzenbaum Scissors, Mayo Scissors, Potts Scissors, Iris Forceps.
References
1. FCI. Sevrin Stevens tenotomy scissors. Current product matrix: straight/curved, blunt/pointed, reusable.
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.
5. DTR Medical. Stevens Tenotomy Scissors instructions for use. DTR.M.035 Rev 1.0, July 2025; applies only to listed single-use references.
6. Uniplex UK. Stevens Tenotomy Scissors. Current product matrix: reusable 11.5-cm pointed/blunt and straight/curved variants.
7. Aspen Surgical. Westcott Tenotomy Scissors 60-1797, with linked general reusable-instrument IFU, Rev 10, 30 Apr 2026.