Surgical scissors are instruments engineered for precise dissection and cutting of tissue or materials within a controlled environment. The ability to use these tools effectively depends entirely on the operator’s grip, which directly dictates the degree of control, stability, and force applied during use. A correct holding technique moves the fulcrum of motion closer to the working end of the instrument, enhancing tactile feedback and minimizing the risk of inadvertent damage. Mastering the proper grip transforms the scissors from a simple cutting tool into a highly responsive extension of the hand.
Understanding the Instrument Parts
A standard pair of surgical scissors consists of several distinct parts, each playing a role in function and grip mechanics. The two large, circular openings at the base are the finger rings, or bows, which serve as the primary point of contact for the operator’s fingers. Extending from the rings are the shanks, which form the long body of the instrument.
The two shanks meet at the box lock, a movable joint that acts as the fulcrum or pivot point for the instrument’s cutting action. This joint is where the mechanical advantage of the scissors originates. Beyond the box lock are the blades, the working ends with sharpened edges that perform the actual cutting. Understanding the precise location of the box lock is fundamental because finger placement near this area maximizes control over the delicate blade tips.
The Standard Tripod Grip
The standard tripod grip is the most widely taught method for handling ring-handled surgical instruments, designed for maximum precision and stability. This grip uses three fingers to establish a stable platform, transferring fine motor control to the working tips of the instrument. The thumb is placed through the upper ring, and the ring finger (the fourth digit) is inserted through the lower ring, ensuring the fingers do not pass beyond the first knuckle joint.
The middle finger rests alongside the outside of the lower ring, providing lateral support and additional force when closing the blades. The index finger rests on the shank of the scissors near the box lock, acting as a guide and stabilizer. Placing the index finger close to the fulcrum allows for accurate direction changes and fine manipulation of the blade tips. This precise finger placement minimizes the potential for the instrument’s tip to wobble, which reduces control. The tripod arrangement allows the thumb to be the primary mover, opening and closing the blades while the other fingers maintain the instrument’s orientation.
Alternative Grips for Specialized Tasks
While the tripod grip offers the highest degree of precision, two alternative grips are used when the surgical task requires either speed or extreme delicacy.
Palm Grip
The palm grip, sometimes called the shearing grip, is employed when cutting tough, non-delicate material like surgical drapes or heavy fascia. This technique involves holding the instrument entirely in the palm, with the fingers wrapped around the shanks and the finger rings resting against the thenar eminence of the hand. The palm grip allows the entire hand to squeeze the scissors shut, generating greater shear force for cutting through resistant materials quickly.
Pencil Grip
The pencil grip, or tip grip, is reserved for small, fine instruments like Iris or Tenotomy scissors. In this technique, the instrument is held between the thumb and index finger, similar to how one holds a writing pen, with the shaft resting on the middle finger. This orientation maximizes the visibility of the fine tips, allowing for minute, highly controlled movements in ophthalmic or microvascular procedures.
Technique for Controlled Cutting
Once the instrument is secured in the tripod grip, the actual cutting technique focuses on controlled, deliberate movements originating from the wrist and thumb. The thumb should be the only digit actively moving, gently sliding back and forth within the ring to open and close the blades with a minimal range of motion. This isolated thumb movement prevents the entire hand from rocking, which would destabilize the cutting line.
For precise dissection, the concept of “walking” the scissors is used, where only the tips of the blades perform the cut, using small, repetitive snips. The blades are inserted into the tissue, opened slightly, and then closed to cut, with the instrument advanced incrementally to control the length and depth of the incision. When using the tripod grip, the wrist and forearm should execute any necessary angle changes, using supination and pronation to orient the blades, rather than bending the fingers or elbow. This approach ensures that the box lock remains the stable fulcrum for the cutting action, preventing tearing and maintaining a clean, continuous cutting plane.