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Kelly Clamp

The Kelly is a ratcheted, ring-handled hemostat used for general hemostasis and blunt dissection on open reconstructive urology and urogynecology trays. Its usual identifying feature is transverse serrations over the distal half of the jaw, with a smooth proximal portion. Straight and curved versions exist. A standard Sklar example is 5½ inches (140 mm); longer and heavier patterns also exist.[1]

Recognition​

InstrumentUseful distinguishing feature
KellyDistal-half jaw serrations; straight or curved.
CrileFull-length transverse jaw serrations; curved versions also exist.[2]
Halsted mosquitoA smaller hemostat pattern with short, fine jaws.
KocherThe common open pattern adds interlocking tip teeth.

The smooth proximal jaw is why the Kelly is commonly taught as the standard tip for the blunt-dissection spread, and as a less crushing choice than a Péan or Kocher for small to moderate vessels. Serration length helps identify the instrument, but it does not establish a validated ranking of closing force, tissue injury or “delicacy.” The Kelly has a blunt tip and no interlocking tooth, which separates it from the Kocher. Inspect the actual jaw geometry, alignment and ratchet rather than choosing by the eponym alone.

Adjacent patterns differ as follows. The Péan has full-jaw serrations and is used for larger pedicles. The Mixter has a right-angle jaw for tunneling around vessels and pedicles.

Reconstructive use​

Kelly forceps can provide temporary hemostasis on an identified bleeding point or hold selected tissue before ligation. They can also assist controlled blunt dissection when the plane and adjacent structures are visible. The manufacturer describes hemostasis, tissue manipulation and soft-tissue dissection; its catalog is not a procedure-specific vascular-control protocol.[1]

Typical uses on open reconstructive and urogynecologic trays:

  • Hemostasis of small to moderate bleeders, including branches of the dorsal venous complex, small vesical and vaginal cuff vessels, flap perforators, scrotal vessels during prosthesis, sphincter and hydrocele surgery, and groin vessels.
  • Blunt dissection along anatomic planes: peri-urethral and peri-prostatic dissection, retropubic space development, vesicovaginal and rectovaginal plane creation during sling, sacrocolpopexy and fistula repair, and mesenteric window development in open diversion.
  • Pedicle clamping before ligation when a Péan or Kocher is more than the pedicle needs, such as ovarian branches, vasal stumps and small uterine pedicles.
  • Suture and drain control, such as clamping a cut ligature end, holding a suture mid-knot or securing a Penrose or red rubber drain.
  • Traction, by leaving a locked Kelly on a cut tissue edge as a pendant weight.

Handling:

  • Blunt dissection (the spread). Insert the closed jaws along the anatomic plane and open them against the tissue. Closing on a small bite picks up a bleeder if one is encountered.
  • Expose before clamping. Avoid blindly taking a broad bite around a bleeding point, particularly near a ureter, nerve, vascular pedicle or repair.
  • Match the instrument to the task. Use a mosquito for fine vessels, a Péan for large pedicles and a Kocher when an interlocking tip tooth is needed. A ratcheted hemostat is not an atraumatic vascular clamp for a vessel intended to remain patent.
  • Use only the necessary closure and traction. “First or second ratchet” does not specify a safe tissue pressure. Small vessels rarely need a full crush. Reassess the bite, then tie below the clamp or release and cauterize.
  • Use blunt spreading selectively. Fine or curved tips do not make forceful spreading safe in an uncertain, scarred or irradiated plane.
  • Protect sutures and tubing. Clamping a disposable suture tail is different from compressing the load-bearing strand. Use an approved tubing clamp when required by the device instructions.

Inspect the tips, joint and ratchet before use. Follow the exact model's reprocessing instructions; a reusable instrument supplied nonsterile requires validated processing before surgery.[1]

Evidence terminology​

“Kellyclasia” or clamp-crush is a liver-transection technique in which parenchyma is crushed to expose vessels and ducts for ligation. The 2026 Cochrane publication comparing bipolar techniques with clamp-crush is a review protocol and reports no results yet.[3] Liver parenchymal crushing is not a handling model for tissue that must survive a urinary reconstruction.

Historical context​

The clamp is named for Howard Atwood Kelly (1858–1943), a gynecologic surgeon and one of the "Big Four" founding professors of the Johns Hopkins School of Medicine with Osler, Halsted and Welch.[4] His work in pelvic surgery includes air cystoscopy[5] and the Kelly plication, the urethral plication used for stress incontinence, which a 680-patient series compared with the Marshall-Marchetti-Krantz and Pereyra procedures.[6]

See also: Crile, Halsted mosquito, Allis, Babcock.

References​

1. Sklar. Kelly hemostatic forceps, 5½ inches, straight, model 17-2055. Manufacturer description and specifications.

2. Sklar. Crile forceps, 6¼ inches, curved, model 17-3162. Manufacturer description and specifications.

3. Kopljar M, Pavić R, Madžar Z, Žiger T. Bipolar coagulation techniques versus the clamp-crush technique for elective liver resection. Review protocol. Cochrane Database Syst Rev. 2026;1:CD016320. doi:10.1002/14651858.CD016320.

4. DuBose JJ, Feliciano DV. "Howard Atwood Kelly (1858–1943) and the Kelly clamp." Am Surg. 2024;90(4):521–2. doi:10.1177/00031348221129513

5. Schultheiss D, Machtens SA, Jonas U. "Air cystoscopy: the history of an endoscopic technique from the late 19th century." BJU Int. 1999;83(6):571–7. doi:10.1046/j.1464-410x.1999.00997.x

6. Park GS, Miller EJ Jr. "Surgical treatment of stress urinary incontinence: a comparison of the Kelly plication, Marshall-Marchetti-Krantz, and Pereyra procedures." Obstet Gynecol. 1988;71(4):575–9. PubMed