Surgical forceps are among the most frequently handled instruments in any operating theatre, yet they are also among the most commonly misidentified. A nurse reaches for an Adson and gets a Gerald; a surgeon asks for a Kelly and receives a Crile. The consequences range from minor inefficiency to compromised tissue handling. Learning to read a forceps by its design—its handle type, jaw pattern, and tip configuration—allows any clinician or sterile processing technician to identify its function at a glance. This article breaks down the major families of common surgical forceps, explains the design logic behind each, and provides a practical framework for identification.
All surgical forceps belong to one of two mechanical families, and this is the single most important distinction for identification. Thumb forceps are spring-loaded tweezers: they grip only while the fingers squeeze, and they release the instant pressure is relaxed. They are instruments of manipulation—used for holding, stabilizing, and dissecting tissue. Locking forceps have ringed handles and a ratchet mechanism that holds the jaws closed without continuous hand pressure. They are instruments of retention—used for clamping vessels, holding tissue bundles, or securing drapes.
This mechanical difference is visible instantly. If the instrument has two simple finger grips and no rings, it is a thumb forceps. If it has two circular rings and a toothed ratchet between them, it is a locking forceps. The distinction matters because the two families are not interchangeable: a thumb forceps cannot hold a bleeding vessel while the surgeon ties a ligature, and a locking hemostat is too bulky and traumatic for delicate dissection.
Within the thumb forceps family, identification hinges on the jaw tip. The tip tells you what the instrument is designed to grasp, and therefore where it belongs in the surgical field.
Toothed thumb forceps carry small interlocking teeth at the tip, most commonly a "1 × 2" configuration—one tooth on one jaw fitting between two teeth on the other. The teeth allow a secure hold on slippery soft tissue with less squeezing force than a smooth jaw would require. Paradoxically, a toothed forceps is often less traumatic than a smooth one, because it does not need to crush tissue to prevent slippage. The practical rule is simple: if the tissue slips, use teeth; if it tears, go smooth.
The Adson forceps is the most refined of the toothed thumb forceps. It has a wide, flat grasp platform that tapers sharply to a fine tip, offering precise control of pressure. It is used for grasping thin skin and light fascial planes, and in its micro configuration, for periodontal and plastic surgery. The standard tissue forceps (sometimes simply called a "tissue forceps") has a straighter, more uniform profile with 1 × 2 teeth, suited to general soft tissue handling. The Semken forceps offers a wider, flatter tip platform than the Adson, while the Gerald forceps places a fine 1 × 2 tip on a longer, slimmer shaft for reach into deeper fields.
Serrated (non-toothed) thumb forceps lack teeth entirely. Their jaws carry fine transverse or longitudinal serrations that grip without puncturing. The DeBakey forceps is the archetype: its jaws have longitudinal grooves with fine horizontal striations, designed for vascular, thoracic, and intestinal surgery where a toothed grip would be catastrophic. The Russian forceps takes a different approach, with a broad, round tip and a grooved perimeter surrounding a concave center. Its grip is spread over a larger area and lacks teeth, making it less traumatic than the Adson or Brown-Adson, though it is less frequently used.
A third variant, the Brown-Adson forceps, carries two longitudinal rows of small, fine intermeshing teeth. This configuration provides a broad but delicate grip, and it is particularly useful for grasping suture needles.
Locking forceps divide into hemostats—designed to crush and occlude vessels—and tissue-holding forceps, designed to grasp tissue without necessarily occluding it. The jaw pattern is the key to telling them apart.
Hemostatic forceps are crushing instruments. Their jaws carry transverse grooves that increase purchase on the vessel wall, and the ratchet allows the surgeon to lock the clamp and move on to the next step. Identification depends on three features: jaw size, serration extent, and groove direction.
The Halstead mosquito forceps is the smallest hemostat, with fine jaws fully serrated to the box lock. It is used only on small vessels, and its delicate configuration makes it unsuitable for larger tissue bundles. The Kelly forceps is a medium-sized hemostat with a defining feature: its transverse serrations are restricted to the distal half of the jaw only. The Crile forceps looks nearly identical but is serrated across the entire jaw surface. This single difference—half-serrated versus fully serrated—is the fastest way to distinguish a Kelly from a Crile on a tray.
For larger vessels and tissue bundles, the Rochester-Pean forceps carries deep transverse grooves over the entire jaw and is available in lengths up to 30 cm. The Rochester-Carmalt forceps is designed for pedicle ligation: its grooves run longitudinally, with only a few horizontal cross-striations at the tips, a pattern that facilitates removal during ligation. The Rochester-Ochsner forceps adds 1 × 2 interdigitating teeth at the jaw tip to prevent tissue slippage. Because of this traumatic grip, it is reserved for tissue that is to be removed.
Not all locking forceps are hemostats. The Allis tissue forceps has ringed handles and a ratchet, but its jaws carry short interlocking teeth designed to grasp and retract tougher tissue that must be held firmly—skin edges, fascia, or a appendix during appendectomy. The Babcock forceps is similar in silhouette but has wider, rounded, smooth-ended jaws. The design is deliberately less traumatic, making it suitable for grasping delicate structures such as bowel without crushing them. When comparing an Allis and a Babcock, look at the jaw: teeth mean Allis, smooth rounded ends mean Babcock.
A small but distinct group of forceps is designed for bone. Rongeurs have double-spring handles rather than finger rings, and sharp scoop-shaped cutting jaws for removing bone spicules or trimming the alveolar ridge. Bone-holding forceps are heavy locking instruments with serrated or pointed jaws for stabilizing bone segments during fracture reduction or cranio-maxillofacial procedures. These are identified by their robust construction and the absence of the fine jaw patterns seen in soft-tissue instruments.
When confronted with an unfamiliar forceps, work through these questions in order:
1. Does it have rings and a ratchet? If no, it is a thumb forceps. Go to step 2. If yes, it is a locking forceps. Go to step 3.
2. For a thumb forceps: are the jaws toothed or serrated? Toothed (1 × 2, 2 × 3, or multiple rows) means a tissue-handling instrument for skin, fascia, or suture needles. Serrated without teeth means an atraumatic instrument for vessels, bowel, or delicate viscera. Check the handle profile: a wide flat platform tapering to a fine tip is an Adson; a longer, slimmer shaft with a fine tip is a Gerald; a broad round tip with a grooved perimeter is a Russian.
3. For a locking forceps: what do the jaw serrations look like? Transverse grooves over the full jaw indicate a Crile or Rochester-Pean. Transverse grooves on the distal half only indicate a Kelly. Longitudinal grooves with cross-striations at the tips indicate a Rochester-Carmalt. Interlocking teeth at the tip indicate a Rochester-Ochsner. If the jaw carries short interlocking teeth along its length rather than serrations, it is an Allis. If the jaw ends are smooth and rounded, it is a Babcock.
4. What is the jaw size relative to the handle? A very small, fine jaw on an otherwise standard handle indicates a mosquito or Halstead hemostat for small vessels. A long, heavy instrument with deep grooves indicates a Rochester-Pean for large tissue bundles.
Correct identification is not merely an academic exercise. In sterile processing departments, instruments must be sorted, inspected, and assembled into procedure-specific trays. A Kelly assembled where a Crile is required may function adequately in some cases, but a mosquito substituted for a Rochester-Pean will fail under load. More importantly, jaw patterns determine tissue trauma: an Allis used on bowel where a Babcock was intended can crush the bowel wall, while a DeBakey used on skin where an Adson was needed will slip repeatedly, prolonging the procedure.
The design of each forceps encodes its intended use. The teeth, serrations, grooves, and ratchets are not decorative variations but functional decisions made by the instrument's designer. Learning to read those decisions—tip first, then jaw, then handle—transforms a tray of similar-looking metal into a legible set of tools, each with a clear purpose and a correct place in the surgical field.
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