Kittner (Peanut) Dissector
A small, purpose-made peanut or dissector sponge held in a ring forceps, Kelly, or mosquito clamp can provide a soft contact surface for blunt dissection and swabbing. A laparoscopic peanut may instead be a pre-mounted instrument. Soft contact does not make forceful dissection injury-free. Also called a peanut or peanut sponge.
Design and Construction
- Size and construction vary by product. For example, Medline lists a 3/8-in (0.95-cm) peanut sponge (MDS72038) and a 9/16 × 1/4-in (1.4 × 0.63-cm) dissector sponge (MDS73512); these are not universal Kittner dimensions. Medline specialty-sponges catalog.
- Held in the jaws of a ring forceps, Kelly, or mosquito, which provides the surgical handle and the controlled point of force application.
- Account for every sponge under the operative count policy; a missing peanut is a retained-item hazard. Medline's listed specialty sponges are X-ray detectable and include a counting mechanism. The WHO safe-surgery guidance specifically calls for soiled dissecting sponges, including peanuts, to be retained in their container or a basin until counted.
- Laparoscopic products are distinct from clamp-held open sponges. Medtronic's Endo Peanut 173019 is a 5-mm, 45-cm, single-use instrument for endoscopic swabbing or soft-tissue blunt dissection; that specification must not be generalized to every laparoscopic peanut. Manufacturer product page.
Reconstructive-Urology and Urogyn Uses
Soft blunt dissection along anatomic planes
The Kittner's signature use is soft blunt dissection, pushing or sweeping along an identified tissue plane under direct visualization. The sponge can broaden the contact surface, but it cannot substitute for recognizing vessels, nerves, and other structures before applying force. The examples below describe possible uses, not a validated instrument preference for each operation.
- Retropubic space (space of Retzius) development during open BNR, AUS placement, anti-incontinence procedures, and Burch / open sling work.
- Recto-vaginal plane during sacrocolpopexy, RVF and rectoneovaginal-fistula repair, and posterior compartment work.
- Vesico-vaginal plane during VVF repair, anterior colporrhaphy, and trans-vaginal sling work.
- Peri-urethral and peri-prostatic dissection during posterior urethroplasty, transperineal RUF repair, and salvage prostatectomy adjuncts.
- Peri-ureteral mobilization during open and robotic ureteral reimplantation, ureteroureterostomy, and Boari-flap reconstruction.
- Peri-cordal and peri-vasal dissection during open and microsurgical vasovasostomy / varicocelectomy when adventitia needs to be cleared without grasping the structure itself.
- Mesenteric-window development during open urinary diversion and augmentation cystoplasty.
- Penile-shaft and peri-corporal dissection during IPP placement, penile-replantation, Peyronie's plication, and peri-tunical work.
- Genital-flap mobilization. Singapore / pudendal-thigh, lotus-petal, IGAP, EPAP, PAP / DFAP, MCFAP dissection.
Hemostasis by tamponade
- Direct pressure with a securely held sponge can temporarily maintain visibility while the bleeding source is identified and definitive hemostasis is obtained as needed.
Tissue retraction and exposure
- The sponge may assist gentle retraction near delicate structures, but pressure on a ureter, nerve, or vasal structure still requires direct visualization and control.
Clearing adventitia from structures
- Wiping or peeling loose areolar tissue, perivesical fat, periadventitial connective tissue off vessels, ducts, and the ureter as part of skeletonization for anastomosis or for vessel exposure during vascular-flap work.
Laparoscopic and robotic use
- A device specifically made for endoscopic use can deliver a soft swabbing or blunt-dissecting surface through a compatible port. The Medtronic 173019 is one documented 5-mm example; product-specific instructions and device integrity still govern its use. The listed reconstructive operations are possible contexts, not evidence that this device improves their outcomes.
Technique
- Loading: seat an approved, counted peanut securely in the chosen clamp so it cannot detach, without excessive compression. The appropriate jaw and ratchet position depend on the specific sponge and instrument; a universal first- or third-ratchet rule is not established.
- Push-and-sweep, not pinch-and-tear: lead with the rounded face of the peanut, follow the plane, let the tissue separate ahead of the Kittner.
- Hemostasis: apply controlled focal pressure and reassess; escalate to definitive hemostasis when needed. A fixed 30–60-second interval is not established for every bleeding source.
- Counted item: keep every peanut within the operative count system and maintain secure control in a deep field. Follow local policy and the product's radiopaque/counting features; an improvised, unaccounted piece of gauze is not interchangeable with a purpose-made counted sponge.
Distinctions from Adjacent Blunt Dissectors
| Tool | What it is | Best fit |
|---|---|---|
| Kittner / peanut | Small counted dissector sponge in a suitable clamp | Soft-contact plane dissection, swabbing, focal pressure |
| Sponge stick | Folded surgical sponge in a ring forceps | Larger-area blunt dissection, vaginal packing |
| Finger dissection | The surgeon's index finger | Coarse plane development, deep-pelvic palpation |
| Closed Kelly "spread to dissect" | Closed jaw opened against tissue | Tighter / firmer planes than Kittner can develop |
| Suction-tip dissection | Yankauer or fine suction probe | Combines dissection with active fluid clearance |
Practical Notes
- For very delicate planes (nerve, fine vessel), use a suitably sized approved dissector and direct visualization; do not assume that a smaller or hand-fashioned sponge is automatically safer.
- For larger planes (deep retropubic space, broad retroperitoneal mobilization), step up to a folded-sponge sponge-stick on a ring forceps.
See also: Ring (Sponge) Forceps, Kelly Clamp, Halsted Mosquito.