Péan Clamp
Ratcheted ring-handled hemostat with full-length transverse serrations along the entire jaw — the heavier-grip relative of the Kelly, used wherever a Kelly slips but a Kocher is more crush than the pedicle requires. Available in straight and curved configurations. The Péan is the historical prototype from which the modern Kelly, Crile, and many other locking hemostatic clamps descend.[1][2]
Design
- Jaws: moderately curved (or straight), full transverse serrations the entire length of the jaw.
- Tip: blunt; no interlocking tooth.
- Mechanism: ring-handled box lock with a multi-position ratchet.
- Length: standard 14–18 cm (5.5–7 in); long Péan 20–24 cm (8–9.5 in) for deep pelvic exposure.
- Material: surgical-grade stainless steel.
Péan vs Kelly — the Serration-Length Distinction
The two clamps are routinely confused and frequently used interchangeably in practice. The defining difference is the length of the transverse serration:[3]
| Feature | Péan | Kelly |
|---|---|---|
| Serrations | Full jaw | Distal half only |
| Grip on tissue | More aggressive across the jaw | More delicate near the tip |
| Best use | Larger pedicles, more crush | Moderate vessels, blunt dissection |
The Péan's full-length serration produces uniform compression along the jaw — preferable when a larger pedicle needs to be held without rotation before tying. The Kelly's distal-only serration is more forgiving for fine work because the smooth proximal jaw does not engage the tissue.
Reconstructive-Urology and Urogyn Uses
- Pedicle clamping prior to ligation on moderate-to-large pedicles — broad-ligament, IP, and uterine pedicles during adjunctive hysterectomy; spermatic-cord branches during open orchiectomy / salvage orchiectomy; ovarian and adnexal pedicles during open POP or fistula repair.
- Hemostasis on larger vessels during open RU work — when a Kelly bite is too small to control the bleeder.
- Tissue-handling and traction during dissection — the Péan's secure grip lets it serve as a pendant clamp on cut tissue edges in deep pelvic fields.
- Vasal stump control during open vasectomy when a full-jaw clamp is preferred over a fine Kelly.
- Adjuvant priapism-shunt work (proximal shunts) where vascular structures are bluntly clamped before division — historically the era when Péan's hemostats made the procedures survivable in the first place.[1]
For smaller / more delicate work, drop down to a Kelly or mosquito; for fascia, dense scar, or pedicles requiring an interlocking tip tooth, step up to the Kocher.
Technique
- Grip: thumb-and-ring-finger through the rings, index along the shank.
- Tip-first grasp: position the curved tip at the pedicle, close to the first or second ratchet, then check for purchase before advancing to a fuller crush.
- Layer-matched alternation: pair the Péan with a Kelly on the same pedicle — Péan above, Kelly below — for the classic "clamp-clamp-cut-tie" sequence on ligation.
- Do not use on bowel, ureter, vessel intended for anastomosis, or any layer planned to remain in situ — full-length serrations are crushing.
Distinctions from Adjacent Hemostats
| Clamp | Serrations | Tip tooth | Best fit |
|---|---|---|---|
| Péan | Full jaw, transverse | No | Larger pedicles, aggressive grip |
| Kelly | Distal half, transverse | No | Moderate vessels, blunt dissection |
| Crile | Full jaw, transverse | No | Hemostasis, similar to Péan |
| Mosquito (Halsted) | Fine, narrow profile | No | Fine vessels, delicate hemostasis |
| Mixter (right-angle) | Variable | No | Tunneling around vessels and pedicles |
| Kocher | Full jaw + 1×2 tip tooth | Yes | Fascia, dense scar, pedicles for ligation |
Historical Context
Named for Jules-Émile Péan (1830–1898), one of the most innovative surgeons of 19th-century Paris and one of the founders of modern hemostatic surgery. Péan is widely credited with developing and popularizing the locking hemostatic forceps in an era before electrocautery — a transformative advance that made major surgery survivable.[1][2] He performed the first recorded total shoulder arthroplasty in 1893 (a platinum-and-rubber prosthesis inspired by Themistocles Gluck)[4] and was an early pioneer of splenectomy and ovariotomy. The arc from Péan's hemostats through the Kelly, Crile, mosquito, and Kocher to today's vascular and atraumatic clamps is one of the defining evolutionary lines in surgical instrumentation.[1]
See also: Kelly, Kocher, Allis, Babcock.
References
1. Sachs M, Auth M, Encke A. "Historical development of surgical instruments exemplified by hemostatic forceps." World J Surg. 1998;22(5):499–504. doi:10.1007/s002689900424
2. El-Sedfy A, Chamberlain RS. "Surgeons and their tools: a history of surgical instruments and their innovators. Part V: pass me the hemostat / clamp." Am Surg. 2015;81(3):232–8.
3. DuBose JJ, Feliciano DV. "Howard Atwood Kelly (1858–1943) and the Kelly clamp." Am Surg. 2024;90(4):521–2. doi:10.1177/00031348221129513
4. Bankes MJ, Emery RJ. "Pioneers of shoulder replacement: Themistocles Gluck and Jules Emile Péan." J Shoulder Elbow Surg. 1995;4(4):259–62. doi:10.1016/s1058-2746(05)80018-7