Crile Clamp
The Crile is a ratcheted, ring-handled hemostat with transverse serrations along the full jaw. It is used for selected hemostasis and tissue control before ligation or cauterization. Straight and curved patterns exist; Sklar's 17-3162 is a curved 6¼-inch (159-mm) example.[1]
Design
- Jaws. Straight or curved, with transverse serrations along the full jaw and a blunt tip without an interlocking tooth.
- Lock. Ring handles with a box lock and multi-position ratchet.
- Size. Lengths around 5½ to 6¼ inches are common. Longer patterns are used for deeper exposure.[1]
Crile versus Kelly
| Feature | Crile | Kelly |
|---|---|---|
| Usual serration length | Full jaw | Distal half of the jaw |
| Curvature | Straight and curved patterns | Straight and curved patterns |
| Closure | Ring handles and ratchet | Ring handles and ratchet |
| Selection | Match actual jaw size and access to the task | Match actual jaw size and access to the task |
Textbooks place the Crile between the Kelly and the finer Halsted mosquito, and it is the instrument most often confused with the Kelly. Serration length is the usual way to tell them apart. These are recognition features, not a reliable force or tissue-injury scale.[1][2] Full-length serrations do not prove uniform pressure across the jaw, and a finer-looking clamp is not automatically safer around nerves or anastomotic tissue.
Uses in reconstructive urology and urogynecology
A Crile can control an identified bleeding point or selected tissue before definitive hemostasis. Adequate exposure is required. Avoid sweeping a blind bite into adjacent viable structures.
- Small and moderate vessels. Bleeders during scrotal, penile prosthesis and hydrocelectomy or varicocelectomy dissection, perforator flap dissection, dorsal venous complex tributaries and periurethral bleeders.
- Small pedicles. Clamping before ligation, for example superficial pudendal branches, scrotal cord tributaries and small adnexal pedicles.
- Blunt dissection. The closed clamp can be advanced into a clearly identified plane and opened to develop it. The finer jaws suit delicate planes, such as periurethral, perivasal and retropubic, better than a Kelly. Jaw size and curvature do not justify forceful spreading near the urethra, vas, rectum or a flap pedicle.
- Suture and drain control. Ligature ends can be held mid-knot, a drain can be secured, and suture tails can be tagged to follow through a layered closure.
Use a Halsted mosquito for finer vessels. Use a Péan for larger pedicles or a firmer grip, and a Kocher when tip-tooth purchase on fascia or a pedicle is needed. A general hemostat is not interchangeable with an atraumatic vascular clamp when a vessel must remain patent. Do not use a Crile on bowel, ureter, grafts or any layer that stays in situ; full-length serrations crush.
Technique and handling
- Grip. Thumb and ring finger through the rings, index finger along the shank.
- Tip-first grasp. Pick up the bleeder at the tip, close to the first ratchet and check control, then tie or cauterize below the clamp.
- Inspect tip alignment, the box lock and ratchet before use; withdraw a damaged instrument from service.
- Use the closure required for the specific tissue and task. No ratchet notch is a universal safe-pressure setting.
- Reassess if the tissue slips or control is inadequate. Repeatedly crushing a wider bite can capture or injure neighboring structures.
- Keep serrated jaws off the working length of fine sutures. A separate tail used for identification is a different task from grasping a load-bearing strand.
- Do not routinely use a metal hemostat to occlude catheters, drains or implant tubing; use the device's specified method.
- Follow the instrument's instructions for cleaning, inspection and sterilization. The cited reusable model is supplied nonsterile.[1]
Comparison with adjacent hemostats
| Clamp | Serrations | Tip tooth | Usual fit |
|---|---|---|---|
| Crile | Full jaw, transverse | No | Small and moderate vessels |
| Kelly | Distal half, transverse | No | Moderate vessels, blunt dissection |
| Péan | Full jaw, heavier jaw | No | Larger pedicles |
| Halsted mosquito | Full jaw, very fine | No | Fine vessels |
| Mixter | Variable, right-angle jaw | No | Passing a tie around vessels and pedicles |
| Kocher | Full jaw with 1×2 tip teeth | Yes | Fascia, dense scar, pedicles for ligation |
Historical context
The clamp is named for George Washington Crile (1864–1943), called the father of physiological surgery in the United States.[3] He also:
- reported in 1905 and 1906 the first significant series of radical en bloc neck dissections, with 3-year survival of 75% after 36 block resections versus 19% in patients without block resection (an earlier extended en bloc dissection was reported by Jawdyński in 1888);[5][6]
- performed the first successful direct human blood transfusion, between two brothers at St. Alexis Hospital, Cleveland, on August 6, 1906, modifying Carrel's anastomosis technique;[7]
- helped introduce intraoperative blood pressure measurement, first used cocaine for regional anesthesia in the United States, proposed anoci-anesthesia to prevent surgical shock, and developed a pneumatic suit that was the forerunner of the aviator's antigravity suit;[3]
- was principal founder of the Cleveland Clinic in 1921 with Bunts, Lower and Phillips,[8] and a founding member and second president of the American College of Surgeons (1916–1917).[3]
He published more than 400 papers and 24 books and died on January 7, 1943, of complications of bacterial endocarditis.[4]
See also: Kelly, Péan, Halsted mosquito, Kocher, Babcock.
References
1. Sklar. Crile forceps, 6¼ inches, curved, model 17-3162. Manufacturer description and specifications.
2. Sklar. Kelly hemostatic forceps, 5½ inches, straight, model 17-2055. Manufacturer description and specifications.
3. Nathoo N, Lautzenheiser FK, Barnett GH. George W. Crile, Ohio's first neurosurgeon, and his relationship with Harvey Cushing. J Neurosurg. 2005;103(2):378–386. doi:10.3171/jns.2005.103.2.0378
4. Soto-Ruiz KM, Varon J. Resuscitation great. George W. Crile: a visionary mind in resuscitation. Resuscitation. 2009;80(1):6–8. doi:10.1016/j.resuscitation.2008.09.008
5. Silver CE, Rinaldo A, Ferlito A. Crile's neck dissection. Laryngoscope. 2007;117(11):1974–1977. doi:10.1097/MLG.0b013e31813544b7
6. Rinaldo A, Ferlito A, Silver CE. Early history of neck dissection. Eur Arch Otorhinolaryngol. 2008;265(12):1535–1538. doi:10.1007/s00405-008-0706-9
7. Nathoo N, Lautzenheiser FK, Barnett GH. The first direct human blood transfusion: the forgotten legacy of George W. Crile. Neurosurgery. 2009;64(3 Suppl):ons20–ons26. doi:10.1227/01.NEU.0000334416.32584.97
8. Soni P, Habboub G, Kshettry VR, et al. Charles E. Locke Jr. (1895-1929): the founder of neurosurgery at the Cleveland Clinic. J Neurosurg. 2019;131(6):1954–1957. doi:10.3171/2018.9.JNS172593