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geekymedics.com/eponymous-surgical-instruments
6 September 2020
Introduction
Despite there being a drive to move away from the use of eponyms, many surgical
instruments are named after the surgeon who first designed and patented them. Here, we
have compiled a list of common eponymously-named instruments as well as a little
information about the surgeon from which they are named – this may help act as a
memory aid.
In addition to their eponymous name, instruments are often also referred to with a
generic name, such as “fine-toothed dissecting forceps” for Adson’s, or “large curved
handheld retractor” for a Deaver. Unfortunately, it is not possible to describe all surgical
instruments in generic terms.
To further complicate things some generic names may refer to more than one instrument,
and some instruments have several different eponymous names. This is because
historically, surgeons and manufacturers wanted to cash in on the lucrative business of
“inventing” and patenting useful surgical instruments (which were often remarkably
similar to one another). Nowadays, most instruments tend to be known by a single
universally accepted name; however, cases of alternative names have also been included
below.
You may also be interested in our general surgical instruments guide or our general
surgical instruments quiz.
Dissecting forceps
Non-toothed forceps have serrated or grooved inner grasping edges which allow them to
hold tissues without damaging them (Figure 1). They are used for delicate tissues such
as vessels, nerves and bowel. This instrument should be handled with great care, as it
generates greater pressure between its’ jaws (vs. toothed forceps), making delicate
tissues extremely vulnerable to crush injury if too much force is applied. Some
eponymously-named non-toothed forceps are described below.
You might also be interested in our surgical flashcard collection which contains over 500
flashcards that cover key surgical topics.
DeBakey
Long non-toothed forceps (18cm) widely used in general surgery and vascular surgery
(Figure 2). Michael Ellis DeBakey was an American cardiothoracic and vascular surgeon
who, in a career spanning 75 years and 60,000 operations, revolutionized his speciality.
As well as inventing his forceps, DeBakey was first to recognise the link between smoking
and lung cancer and he performed the first-ever carotid endarterectomy. Similarly, he
devised the DeBakey procedure for aortic dissections. Debakey then underwent his own
self-named procedure and survived at the age of 97!1
McIndoe
Medium-length fine non-toothed forceps (15cm) widely used in general surgery and
vascular surgery. Less-frequently encountered, a toothed variety is also available. Sir
Archibald McIndoe was a plastic surgeon from New Zealand, best known for his work
treating RAF fighter pilots with major burns during WWII. A group of his patients and
colleagues formed a drinking club called the “Guinea Pig Club”, which still meets for the
occasional beer 65 years later.2
Adson
Short fine non-toothed forceps (12.5cm) widely used in neurosurgery, ENT and plastic
surgery, when handling more delicate tissues. Alfred Washington Adson was a pioneering
American neurosurgeon, giving his name to a number of syndromes and manoeuvres,
including Coffey-Adson syndrome – more commonly known as thoracic outlet syndrome.
He worked at the Mayo Clinic from 1914 until his death in 1951.3
*Less commonly used non-toothed forceps include: generic very long non-
toothed forceps (20-25cm), extremely long St Mark’s Hospital forceps (29cm) and
Russian pattern forceps (which have oval cup-shaped ends), Gillies, Canadian, Emmett’s,
Iris, Maingot, Moorfield fixators, Ramsey, and turn-over-end forceps.
Toothed forceps
Toothed forceps have one or more sharp triangular “teeth” on their inner grasping edges
which interdigitate with one another when the forceps are closed (Figure 3). They pierce
tissues and allow them to be grasped firmly with the application of less pressure than is
required with non-toothed forceps. This reduces the risk of crush injury. Toothed forceps
are used for tougher tissues which can tolerate being punctured, such
as skin, subcutaneous fat, fascia, muscle and tendons. This instrument should not be
used on vessels, nerves or bowel, as puncturing these could lead to clinical
complications.
Adson toothed
Short fine-toothed forceps (12.5cm) widely used for delicate work in plastic surgery and
neurosurgery (Figure 4). You will remember the ever-industrious Alfred Washington
Adson from our exciting encounter with his non-toothed forceps above.
Figure 4. Adson toothed forceps19
Gillies
Jean’s
Medium-length toothed forceps (14-18cm) with up to three teeth, inwardly-bent ends and
a line of circular holes running along their arms, used in general surgery. Less-frequently
encountered, a non-toothed variety is also available. Despite having looked for the
mysterious “Mr Jeans”, no information can be found about him. It may instead be that
they are not named after an individual – as suggested by the description of an original
Jean’s forcep held in a museum. Hopefully, their characteristic appearance alone will help
you to remember them.
Waugh
Long fine-toothed forceps (20cm) widely used in general surgery and ENT. A non-toothed
variety is also available but is less commonly encountered. Alexander Waugh was by all
accounts, a fearsome drunken brute of a man whose surgical notoriety peaked with the
invention of his forceps. He was also the grandfather of the novelist Arthur Evelyn Waugh
best known for his novel ‘Decline and Fall’.5
Lanes
Heavy toothed forceps (12.5-20cm) with up to 3 teeth, widely used in general surgery and
orthopaedics for grasping tough thick tissue and manipulating large needles (e.g. when
closing a laparotomy wound) (Figure 6). Sir William Arbuthnot Lane was an English
baronet who mastered ENT, orthopaedic and abdominal surgery whilst working at Guy’s
Hospital in London. He is best known for pioneering aseptic technique, internal fixation of
fractures, neonatal cleft palate repairs and colectomy techniques. One colleague
described him as “a master who dared where others quailed”.6
Bonney
Long, heavy-toothed forceps (18cm) (similar to Lanes), widely used in general surgery
and orthopaedics. Victor Bonney was a British gynaecologist who led the way in radical
hysterectomy for cervical cancer, fertility-preserving uterine myomectomy for fibroids and
ovarian cystectomy. He remains the only gynaecologist ever to be elected to the council
of the Royal College of Surgeons.7
*Other less commonly used toothed forceps include: extremely long St Mark’s Hospital
forceps (29cm), Leedham Green (4 teeth), Bickford, Braithwaite, Continental pattern, Iris,
Ramsey, and Treves’ forceps.
Other forceps
As discussed in the general surgical instruments article, forceps are shaped much like
scissors except instead of two opposing blades the working ends of forceps oppose
each other much like the dissecting forceps.
The benefit of the forcep shape is that it incorporates a ratchet allowing for tissue to be
grasped and held by the instrument easily. As you’ll note in the below instruments, the
working ends of forceps vary to a much greater extent than simple dissecting forceps.
You may also hear some of these forceps referred to as ‘clamps’ or ‘haemostats’ – this
reflects their use for clamping down onto tissue or compressing an artery to stop
bleeding.
There are a number of medium length forceps which all appear extremely similar to each
other, the Kelly, Dunhill and Birkett are just a few. The ‘Birkett’ which is named after the
British surgeon and early pioneer of histopathology John Birkett12 whilst the ‘Dunhill’
forcep is most likely named after Sir Thomas Peel Dunhill a thyroid surgeon and physician
to the Queen.14
Allis
A long thin clamp with sharp teeth used to hold heavy tissues such as fascia, breast or
bowel tissue without damaging underlying tissues. Created by Oscar H. Allis, a pioneering
general and orthopaedic surgeon who was the first to successfully perform bowel
anastomoses. Allis is also known as the originator of the Allis sign, also known as the
Galeazzi test, an assessment of hip dysplasia in children.8
Babcock
Medium length forceps with widened ends. The Babcock forcep has one of the most
iconic shapes and is designed to grasp delicate tissues without causing trauma. William
Babcock, an obstetrician and gynaecologist turned surgeon is also known for performing
a cranioplasty – or closure of the skull – using ‘soup bones’.9
Lanes
Medium length forceps with a single toothed end. Lanes, in my opinion, look like a
combination of an Allis and a Babcock, a wide working end that tapers down to a single
tooth. Used commonly throughout general surgery, this instrument is named after the
same Lane as its dissecting forceps counterpart.6
Mosquito
A small length forceps with a curved or straight end featuring small interlocking ridges
lining the jaws. Mosquito forceps are haemostatic forceps designed for controlling
bleeding and handling small blood vessels during surgery. Known also as the ‘Halsted-
mosquito’ these forceps were invented by William Halstead, a founder of John Hopkins,
an early proponent of aseptic technique and champion of anaesthetics. Unfortunately, as
a result of experimenting with early anaesthetic drugs, he became addicted to both
cocaine and morphine.10
Kelly
Medium length forceps with small interlocking ridges lining long straight or curved jaws.
Dr. Howard Atwood Kelly was an American gynaecologist and one of the founding
professors at Johns Hopkins University. He also collected snakes as a hobby and was
famous as a hardcore Christian fundamentalist who called prayer meetings before every
operation and staunchly opposed any form of birth control.11
Littlewoods
Medium length forceps with small interlocking teeth on the end of the longer arm. These
forceps were designed to hold the skin edges of an abdominal wound by Harry
Littlewood, a professor of surgery in Leeds. He is also the presenter of the first-ever
recorded ‘ovarian gestation’ – where an ectopic pregnancy progresses within the ovary
itself.13
Roberts
Long straight or curved forceps with small ridges lining the jaws. The Roberts forcep is
like a large version of the Birkett/Kelly forcep (or an XXL version of a mosquito). These
forceps are haemostatic and used to compress large blood vessels. Named after David
Lloyd Roberts a gynaecologist and collector of books, upon his death he bequeathed over
3000 medical texts to the Royal College of Physicians in London.15
Surgical scissors are extremely varied in shape for something as simple as a scissor, this
is due to their many uses – for cutting different tissues at different angles, but also for
cutting suture thread or other materials needed during surgery. Often scissors have black
or coloured handles to make them easy to identify.
Mayo
A short and relatively ‘fat’ pair of scissors compared to others, available in both curved
and straight blades, mayo scissors are used for cutting tissues near the surface of
wounds. If you’re assisting a surgeon by cutting their sutures, you’ll probably be using
Mayo scissors. The Mayo scissors were developed originally by surgeons at the famous
Mayo Clinic.16
Metzembaum
The most common scissor in organ-related operations, these scissors are relatively
short-bladed compared to their long arms and often have a blunt tip. Used for blunt
dissection (separate of tissue) and delicate cutting they are named after Myron Firth
Metzenbaum, an American surgeon who specialised in oral and reconstructive surgery.16
You may hear them referred to as ‘Metz’.
Jameson’s
A long scissor, similar to the Metz. The scissor blades are thinner to allow more specific
dissection at depth inside the abdomen. The Jameson scissor may be named after
James Jameson, a British army officer and founder of the Royal Army Medical Corps.18
Potts
Sharp pointed scissors with a bevelled outer edge, allowing for both blunt and sharp
dissection without changing instruments. The Pott’s scissors are one of the many
instruments invented by Willis J. Potts, a paediatric surgeon and creator of the
aortopulmonary artery shunt – a treatment that prolonged the lives of many children with
cyanotic heart disease.19
Figure 8. Surgical scissors, from left to right: Metz
curved, Jamieson’s, Metz straight, Mayo curved
and straight, Potts
Retractors
Retractors are used to hold incisions open and move structures such as skin, fascia and
internal organs out of the way. They are essential surgical instruments, as they ensure
optimal exposure of the operative field. This maximises the surgeon’s visibility and ability
to safely reach deep structures, and provides a bigger workspace for dissection, suturing
and knot tying. Retractors can be categorised into “handheld,” “self-retaining” and “table-
mounted”.
Handheld retractors
This is a small handheld retractor with one to six curved toothed blades, commonly used
for retraction of small delicate incisions in plastics, hand surgery, vascular surgery and
ophthalmology. The teeth can be either blunt or sharp, so do try not to stab yourself!
Langenbeck
Thin, right-angled handheld retractors which are available in several sizes ranging from
small (or “baby”) to large, probably used in every surgical speciality…with the exception of
ophthalmology. They are extremely useful instruments which are used to retract or lift
superficial wound edges. Bernard von Langenbeck was a German military surgeon
famous for developing the world’s first surgical “residency” programme for trainees at his
hospital in Berlin.20
Figure 9. Langenbeck retractors19
Morris
Large, right-angled handheld retractors with a lip at the end of their long blades to help lift
and protect the organs being retracted (Figure 11). Some designs also have a groove
which can be used to hold a fibreoptic light source. These are used to retract wound
edges and organs during deep abdominal and pelvic surgery. St Mark’s Hospital in
London began in 1835 as a seven-bedded “Infirmary for the Relief of the Poor afflicted
with Fistula and other Diseases of the Rectum”, and is now a world-renowned specialist
centre for patients with intestinal and colorectal disease.22
Moynihan
A small, curved handheld retractor, similar in function to a Langenbeck and used for
retracting superficial wound edges in general and orthopaedic surgery. Sir Berkeley
Moynihan was a celebrated British general surgeon and anatomist who founded the
Association of Surgeons and British Journal of Surgery.23
A medium-sized, roundly curved handheld retractor classically used to retract the bladder
downwards and keep it covered during a lower segment Caesarean section (Figure 12). It
is also widely used in general surgery and obstetrics and gynaecology to retract the
bladder and other internal organs. Eugène-Louis Doyen was a controversial French
surgeon, fencer and sharpshooter who developed surgical instruments and techniques
which allowed him to operate with legendary speed and minimal blood loss at a time
when anaesthetics were deadly and artificial ventilation did not exist. He also produced
some of the first films of surgical operations, including the separation of conjoined twins
in 1902.24
Deaver
A large curved handheld retractor available in a range of sizes and widely used in general
surgery to retract wound edges and abdominal organs. A wet swab (see disposables) or
pack is often placed as an interface between the retractor and any solid organs, to
minimise the risk of iatrogenic trauma. Dr John Blair Deaver was an American general
surgeon who pioneered techniques in the surgical management of early acute
appendicitis. He was a viciously witty and much-loved teacher, although his trainees soon
became sick of holding his heavy retractor for long periods, calling it “Death by Deaver.” 25
Kelly
A long, curved handheld retractor used in general surgery to retract deep abdominal and
pelvic structures, for example during anterior dissection of the rectum. Dr. Howard
Atwood Kelly was an American gynaecologist and one of the founding professors of
Johns Hopkins University. He also collected snakes as a hobby and was famous as a
hardcore Christian fundamentalist who called prayer meetings before every operation and
staunchly opposed any form of birth control.11
A long, heart-shaped handheld retractor used in general surgery to retract deep organs
such as the liver and intestines. Dr Paul Randall Harrington was an American orthopaedic
surgeon, best known for developing Harrington spinal rods for the correction of scoliosis
in survivors of the US polio epidemic.26
*Other less commonly encountered handheld retractors include Canny-Ryall retractors,
Czerny retractors, Durham retractors, and US Army retractors.
Self-retaining retractors
Self-retaining retractors all have a similar appearance – two long-toothed arms that
spread apart which are held in place via a ratchet. These allow retraction of tissues for
long periods of time and do not require a surgeon to hold them, as they can rest against
the patient’s body.
Norfolk-Norwich
A self-retaining retractor involving 4-5 interlocking teeth at the end of long arms typically
used in vascular surgery. Named after a hospital in the South-East of England, these were
likely first implemented or used there.
Travers
Table-mounted retractors
A larger form of the self-retaining retractor is the table-mounted retractor. These screw or
clamp onto the operating table and can retract tissue from a wide range of angles for
long periods of time.
Layla retractor
This is a famous example invented by Mahmut Yasagil after he was inspired by his
daughter’s wooden articulating toy snake. The snake had a string running through the
middle which, if pulled taught, would hold the wooden segments in position regardless of
the snake’s orientation. Yasagil is considered to be one of the greatest neurosurgeons of
the twentieth century.29
These retractors are other examples of complex table-mounted retractor systems, they
are commonly used in large complex abdominal operations.
Conclusion
There are, of course, many more instruments with eponymous names- too many to go
through in one article! If you ever see instruments being used which you’ve never seen
before or don’t understand the use of, ask! The scrub staff are extremely knowledgeable
about instruments. If you have questions about the specific uses of instruments – I
would strongly recommend being inquisitive – you’ll look interested and it’s a great way
to get to know the team better.
The best way to get familiar with instruments is to handle them, which means scrubbing
in and assisting in operations. Good luck!
Check out our general surgical instruments quiz to put your knowledge to the test!
References
Acknowledgements
Many thanks to Bethanie William ODP for supplying images of instruments (Figures 6-
11).
Reviewer
Mr Robert Pearson
Editor
Hannah Thomas