Jacobs Tenaculum
Ring-handled cervical / vaginal-cuff grasper with multiple short interlocking teeth (typically 3–4 per jaw) — the multi-tooth counterpart to the single-tooth tenaculum. The broader jaw distributes traction force over a larger tissue area, giving a less penetrating but more spread-out grip that is better suited to friable / atrophic cervix and the vaginal cuff after hysterectomy — both common scenarios in urogyn practice. Also called the Jacobs vulsellum forceps.
Design
- Two opposing jaws, each with multiple short interlocking teeth (typically 3–4 teeth per jaw).
- Teeth are shorter and less deeply penetrating than the single deep tooth of the standard tenaculum.
- Broader jaw width gives a wider area of tissue contact.
- Ratcheted ring handles allow controlled incremental closure.
- Stainless steel, autoclavable.
Reconstructive-Urology and Urogyn Uses
The Jacobs is the workhorse multi-tooth tenaculum for situations where the single-tooth design tears through or leaves a single puncture wound:
- Friable, atrophic, or scarred cervix — postmenopausal patients in the urogyn / RU clinic, prior cervical surgery, prior LEEP, after pelvic radiation.
- Vaginal-cuff grasping after hysterectomy — multi-tooth grip distributes load across the cuff edge during cuff revision, mesh-exposure excision, vaginal-vault fistula repair, or apical-prolapse repair.
- Cervical traction during vaginal hysterectomy and sacrocolpopexy with uterine preservation when broader grip is preferable.
- Cervical stabilization for transcervical instrumentation (IUD, endometrial biopsy, hysteroscopy, Hegar dilator cervical dilation) when the operator wants less concentrated trauma than the single-tooth design.
Single-Tooth vs Jacobs vs Atraumatic Alternatives
| Feature | Single-tooth tenaculum | Jacobs (multi-tooth) | Allis clamp / atraumatic vulsellum |
|---|---|---|---|
| Grip mechanism | Single deep penetrating tooth | Multiple shorter interlocking teeth | Broader serrated or atraumatic clamp |
| Traction security | Highest | Moderate — wider load distribution | Lower on slippery cervix |
| Tissue trauma | Single puncture wound | Multiple shallow punctures | Minimal puncture |
| Bleeding | ~ 55% in Andrews 2023 RCT[1] | Intermediate (not directly randomized) | 6.3% (Allis) / shorter time to hemostasis (vulsellum)[1][2] |
| Best fit | Mobile parous cervix needing strong axial traction | Friable / atrophic cervix, vaginal cuff | When grip-security is secondary to atraumatic handling |
The Jacobs occupies the middle ground between the deeply penetrating single-tooth tenaculum and the fully atraumatic alternatives.
Limitations and Evidence Notes
- Slips on a very mobile or atrophic cervix more often than a single-tooth tenaculum because no single point penetrates deeply.
- Limited head-to-head comparative data specifically evaluating the Jacobs vs the single-tooth tenaculum or vs Allis / vulsellum alternatives — most published RCT data on cervical-stabilization devices use the single-tooth and Allis arms. Clinical-practice tradition and instrumentation references drive the Jacobs's continued use rather than randomized evidence.[1][2]
See also: Single-Tooth Tenaculum, Allis Clamp, Ring (Sponge) Forceps, Hegar Dilators, Auvard Weighted Speculum.
References
1. Andrews B, Quick K, MacLeod E, Edwards K, Rone BK. "Cervical bleeding with cervical stabilization during IUD placement: Allis clamp versus single-tooth tenaculum, a randomized control trial." Arch Gynecol Obstet. 2023;307(4):1015–9. doi:10.1007/s00404-022-06784-x
2. Doty N, MacIsaac L. "Effect of an atraumatic vulsellum versus a single-tooth tenaculum on pain perception during intrauterine device insertion: a randomized controlled trial." Contraception. 2015;92(6):567–71. doi:10.1016/j.contraception.2015.05.009