Kocher Clamp
Kocher jaw detail: serrations and an interlocking tip tooth. (Image: Wikimedia Commons, public domain.)
The common Kocher tissue or hemostatic clamp has ring handles, a ratchet, serrated jaws and 1×2 interlocking teeth at the tip. Sklar describes it as a heavy instrument designed to grasp medium to heavy tissue aggressively or occlude heavy, dense vessels; full-length serrations plus tip teeth give a firm grip. The tooth can penetrate and the jaws can crush; this is not a clamp for delicate vessel, bowel, ureteral or other tissue that must remain in situ.[1][2]
Identify the pattern
Kocher, Ochsner and Rochester-Ochsner names overlap in instrument catalogs, but size, weight and jaw pattern vary. Check the complete product name.
| Feature | What to inspect |
|---|---|
| Tip teeth | The single tooth fits between two opposing teeth; verify alignment and integrity. |
| Serrated jaws | Standard examples have transverse serrations along the jaw, unlike a merely toothed tip. |
| Straight or curved shaft/jaws | Select for the access and intended tissue bite. |
| Ratchet and joint | Confirm engagement and release. |
The tip tooth is the anti-slip feature. On dense fascia or a thick pedicle, serrations alone allow rotation under traction, and the interlocking tooth holds the tissue at the tip. The same tooth is why the clamp injures any layer that must keep its wall or serosa. Sklar's Rochester-Ochsner 17-2862 is a straight 6¼-inch example. Longer Kocher models and more delicate patterns exist.[1][2]
Reconstructive use and limits
- Fascial traction and closure: selected edges may tolerate a toothed grasp, for example rectus fascia and external oblique aponeurosis during open bladder neck, augmentation, diversion and re-do laparotomy closures, and the cut end of a rectus fascia strip during pubovaginal sling harvest. Preserve tissue needed for closure.
- Specimens or tissue planned for excision: firm purchase is useful for urachal remnants, partial cystectomy or nephrectomy specimens, excised lichen sclerosus vulvectomy skin and the spermatic cord before orchiectomy for an infected prosthesis, provided adjacent viable structures are protected.
- Pedicle work: broad ligament, ovarian and infundibulopelvic pedicles during open hysterectomy and oophorectomy are clamped before ligation.
- Reoperative or irradiated tissue: a Kocher can hold dense scar during re-do diversion, augmentation, AUS or post-radiation pelvic re-entry. Avoid forceful clamp traction to create an unconfirmed plane.
- Drape and towel work when a strong locking clamp is needed.
Use a tissue-preserving strategy for anastomotic edges, grafts and fragile viscera: a Babcock or DeBakey for bowel and ureter in situ, and an Allis for vaginal cuff and mesh edges. An Allis is also toothed, and a Babcock can still compress. For traction, close only enough to hold the intended tissue securely and assess the grasp. Reserve a full crush for pedicles about to be ligated and divided. Remove the clamp as the operative step permits, because prolonged crush with rotation can twist and tear tissue, and assess the tissue before proceeding.
Choose by the actual jaw geometry and task. The usual teaching order of grip, from the least to the most traumatic, is Babcock, Allis, then Kocher; catalog patterns overlap.
| Clamp | Tip and serrations | Typical fit |
|---|---|---|
| Kocher | 1×2 tip tooth, transverse serrations | Fascia, dense scar, pedicles, discarded tissue |
| Allis | Short interlocking teeth | Skin, fascia, vaginal cuff, resected tissue |
| Babcock | Smooth, fenestrated | Bowel, ureter, hollow viscera in situ |
| Kelly | Distal-half serrations, no teeth | Small vessel hemostasis, dissection |
| Rochester-Carmalt | Longitudinal and transverse cross-hatch, no tip tooth | Large pedicles, tissue bundles |
The tip tooth separates the Kocher from the otherwise similar Rochester-Carmalt.
Historical context
The clamp is named for Emil Theodor Kocher (1841–1917) of Bern, who received the 1909 Nobel Prize in Physiology or Medicine for thyroid surgery and was the first surgeon to win it. He introduced many instruments, of which the Kocher clamp is still in use.[3]
See also: Allis, Babcock, DeBakey forceps.
References
1. Sklar. Rochester-Ochsner forceps, 6¼ inches, straight, serrated, 1×2 teeth, model 17-2862. Manufacturer description and specifications.
2. Sklar. Kocher forceps, curved, 20 inches, model 61-2103. Manufacturer description and specifications.
3. Bumbasirević MZ, Zagorac SG, Lesić AR. "Emil Theodor Kocher (1841–1917): orthopaedic surgeon and the first surgeon Nobel Prize winner." Acta Chir Iugosl. 2013;60(3):7–11. doi:10.2298/aci1303007b