Kittner (Peanut) Dissector

A small, tightly rolled cotton or gauze peanut-shaped sponge held in a ring forceps, Kelly, or mosquito clamp — the workhorse soft blunt dissector for atraumatic plane development in open and laparoscopic reconstructive urology and urogynecology. Also called a peanut, pusher, pledget, or peanut sponge.

Design and Construction

Small, tightly compressed cotton or gauze, typically peanut- or torpedo-shaped, 1–2 cm long.
Held in the jaws of a ring forceps, Kelly, or mosquito — the clamp provides the surgical handle and the controlled point of force application.
Disposable, single-use, and counted like any sponge — a Kittner left in a closed cavity is a retained foreign body, so the OR sponge count accounts for every peanut.
Available in standard open and laparoscopic / trocar-compatible formats; the laparoscopic Kittner is pre-mounted on a long shaft that passes through a standard 5 mm or 10 mm port.

Reconstructive-Urology and Urogyn Uses

Atraumatic blunt dissection along anatomic planes

The Kittner's signature use is soft blunt dissection — pushing, sweeping, or peeling tissue along the natural plane it already wants to follow. The technique pairs the tactile feedback of the clamp shaft with the broad, atraumatic surface of the peanut so that the surgeon develops the plane without dividing structures the eye has not yet identified.

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 on a small bleeder maintains visibility while the bleeder is controlled by cautery or suture-ligation in turn. The Kittner is the routine instrument for this because the soft surface conforms to the vessel and the clamp positions it precisely.

Tissue retraction and exposure

Pushed against tissue to lift or retract delicate structures (ureter, nerve, vasal cord, dorsal nerve of the penis) without grasping them.

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

Robotic and laparoscopic peanut dissectors deliver the same atraumatic plane development at depth through a trocar — particularly useful in robotic sacrocolpopexy, robotic ureteral reimplant, robotic VUR repair, and robotic peritoneal-flap vaginoplasty.

Technique

Loading: open the ring forceps jaws, place the Kittner symmetrically across the rings, close to the first ratchet — third-ratchet crush deforms the peanut and reduces its working volume.
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: hold focal pressure for 30–60 seconds, then assess — re-apply or escalate to cautery / suture-ligation if the bleeder is not controlled.
Counted item: every Kittner is on the sponge count; never leave one in a closed cavity, and never use one in a wound without a string or clamp attached if the field is deep.

Distinctions from Adjacent Blunt Dissectors

Tool	What it is	Best fit
Kittner / peanut	Small cotton / gauze peanut in a ring or Kelly	Soft atraumatic plane dissection, focal hemostasis
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), step down to a smaller mosquito-held peanut or a hand-fashioned smaller peanut; the standard ring-forceps-held Kittner is too coarse.
For larger planes (deep retropubic space, broad retroperitoneal mobilization), step up to a folded-sponge sponge-stick on a ring forceps.

Design and Construction​

Reconstructive-Urology and Urogyn Uses​

Atraumatic blunt dissection along anatomic planes​

Hemostasis by tamponade​

Tissue retraction and exposure​

Clearing adventitia from structures​

Laparoscopic and robotic use​

Technique​

Distinctions from Adjacent Blunt Dissectors​

Practical Notes​