How to Hold Surgical Instruments: Correct Grips for Scissors, Needle Holders and Forceps

How to hold surgical scissors

For ring-handled scissors the standard teaching is to place the tip of the thumb and the tip of the ring finger in the rings, not deep in them. The index finger rests on the shaft near the box lock, which gives stability and control over the tip, and the middle finger supports the ring. Pushing the thumb all the way through the ring reduces control.

Cut with the tips of the blades for fine dissection and the proximal part for heavier tissue. Move from the wrist and fingers rather than the whole arm. The REDA scissors range includes Metzenbaum, Mayo, iris and micro patterns whose size and balance influence how comfortable each grip feels.

Needle holder how to hold: thumb-ring and palmed grips

The needle holder is traditionally held with the thumb and ring finger in the rings and the index finger along the shaft, as with scissors, which gives the best control for fine suturing. With a ratchet, the thumb-ring hold allows quick locking and unlocking. In deep cavities, many surgeons use a palmed grip, where the handle rests in the palm with the thumb and fingers closing it.

The needle driver is loaded with the needle held about two-thirds from the tip toward the swage, at right angles to the jaws. REDA's needle holder range includes Mayo-Hegar, Crile-Wood, Ryder, Webster and DeBakey patterns as well as Castroviejo and Barraquer micro needle holders, and the grip varies between these. See how to load a needle holder and the needle holder types article.

• Thumb-ring grip: precision and quick ratchet control.
• Palmed grip: depth and speed in cavities, less fine control.
• Micro needle holders: pencil grip, rolled between the fingers.

How to hold surgical forceps

Thumb forceps are held like a pen, between the thumb and the first two fingers, with the web of the hand supporting the base. The pressure comes from the thumb and fingers closing the arms, and it should be just enough to hold the tissue. Grasping too far from the tip makes the jaws splay and lose precision.

The forceps are held in the non-dominant hand for tissue handling during suturing. Toothed patterns hold skin and fascia securely with less pressure, while atraumatic tips protect vessels and delicate tissue. The comparison is in surgical vs anatomical forceps.

Haemostats and ratchet handling

Haemostats and clamps are held with the thumb and ring finger like scissors. To lock, squeeze the rings until the ratchet engages, usually on the first or second tooth for light compression. To release, press the thumb and ring finger together slightly, then rotate or slide them apart in opposite directions, so the box lock and teeth disengage without a jerk.

A common mistake is a forceful release which snaps the clamp open and may damage tissue. The same technique works with the instruments in REDA's forceps and clamps range. Watch for the ratchet that fails to hold; it needs repair.

Common mistakes and practice

Common problems are placing the thumb too far into the ring, gripping forceps like a fist, using the tip of scissors for tissue they cannot cut, and pulling the instrument in an arc rather than keeping the wrist stable. Practise on simulated tissue, with an experienced instructor, and under the supervision rules of your institution.

A clinical team learning the full range of instruments will find how to learn surgical instruments helpful. Beckfinity's specialists can supply teaching and training sets from the REDA range on request, subject to current MOHAP, DHA or DOH requirements.