The Kelly clamp is a specialized surgical instrument, formally categorized as hemostatic forceps, designed to manage bleeding during medical procedures. This common tool is named after its inventor, Dr. Howard Atwood Kelly, the clamp was developed in the late 19th century and is now foundational equipment in virtually every operating room. Its primary purpose is to temporarily secure blood vessels or tissue bundles, controlling blood loss and providing surgeons with a clear field of view.
Anatomy of the Kelly Clamp
The design of the Kelly clamp resembles a pair of scissors, but features blunt, gripping jaws instead of sharp blades. Like other hemostatic forceps, the instrument is composed of four distinct sections that contribute to its functionality. The finger loops, or rings, allow the surgeon to manipulate the instrument with precision.
Connecting the finger rings to the working end is the shank, or shaft, which provides the necessary length to reach structures within the surgical field. A locking mechanism, known as the ratchet, is located near the finger rings. The ratchet allows the surgeon to close the jaws and maintain a consistent, secure grip without continuous manual pressure.
The working end consists of the jaws, which grasp tissue or vessels. A distinguishing feature is the pattern of its serrations, which are horizontal ridges on the inner surface of the jaws. These serrations only extend partway down the length of the jaw, typically covering only the distal third to half of the surface. Kelly clamps are available with either straight or gently curved jaws, with the curved variety often favored for better access in deeper surgical sites.
Surgical Uses and Applications
The primary application of the Kelly clamp is achieving hemostasis, the temporary control of bleeding. Surgeons use the clamp to grasp and compress a blood vessel, stopping the flow of blood. This occlusion minimizes blood loss and allows the vessel to be safely ligated, or tied off with a suture, before being cut.
The instrument is particularly suited for clamping medium to large blood vessels and substantial tissue bundles. Its robust design and the strength of the ratchet mechanism make it reliable for securing structures that require a firm hold. Once the jaws are locked, the clamp remains in place to maintain pressure.
Beyond controlling bleeding, the Kelly clamp serves several secondary functions. It is routinely used for grasping and holding tissues, assisting in retraction to improve the surgical view. The blunt tips of the closed jaws can also be used for blunt dissection, carefully separating layers of tissue. Furthermore, the clamp can manage suture ends or temporarily secure medical tubing during a procedure.
How Kelly Clamps Differ from Other Hemostats
The term hemostat is a general category for instruments used to control bleeding, and the Kelly clamp is one specific design within this family. Kelly clamps are frequently compared with other common hemostatic forceps, primarily the Crile clamp and the Halsted Mosquito clamp.
The key difference between the Kelly clamp and the Crile clamp lies in the extent of the serrations on the jaw. A Kelly clamp features serrations that cover approximately the distal half of the jaw, leaving the proximal half smooth. In contrast, the Crile clamp, which is similar in overall size, has transverse serrations that run the entire length of the jaw surface. This distinction in serration length means the Kelly is often selected for clamping larger vessels or tissue masses, while the Crile is frequently used for medium-sized vessels.
The Halsted Mosquito clamp is significantly smaller and more delicate than the Kelly clamp. Mosquito clamps are specifically designed for fine, precise work in confined spaces, such as clamping small capillaries and tiny blood vessels. While all three instruments serve the function of hemostasis, their differences in size and jaw serration pattern determine their specific roles.