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Maryland Bipolar Forceps (da Vinci)

EndoWrist articulating bipolar forceps with a fine, curved Maryland-style tip (Intuitive Surgical) — the workhorse robotic dissecting forceps for precise dissection, grasping, incision, and coagulation in a single instrument. The default working instrument for the left-hand role in most robotic urogyn / reconstructive-urology cases: robotic sacrocolpopexy, robotic-assisted ureteral reimplantation, Boari-flap reconstruction, transvaginal-mesh excision, vesicovaginal-fistula repair, robotic radical prostatectomy reconstructive steps (DVC, posterior reconstruction), and the bench-and-grasp work that the right-hand monopolar curved scissors complements.[1][2]

Design​

  • Fine curved Maryland-style tip for accurate dissection in tight planes.
  • EndoWrist articulation — 7 degrees of freedom — functions like a right-angle dissector around vessels, ureter, NVB, vasa, and obturator nerve.[3]
  • 5 mm for da Vinci Si / Xi; 6 mm for da Vinci SP.[4]
  • Optional auto-stop function terminates bipolar energy at maximum impedance (tissue coagulation complete); some surgeons disable for surgeon-directed energy.[5]

Reconstructive-Urology and Urogyn Uses​

The Maryland bipolar is the default left-hand instrument across the robotic urogyn / RU portfolio:

  • Robotic sacrocolpopexy — promontory exposure (right-angle pass-around the middle sacral vessels), peritoneal incision, paravaginal-tunnel development.
  • Robotic-assisted ureteral reimplantation, Boari flap, psoas hitch, ureteroureterostomy — ureteral mobilization with vessel-loop equivalent atraumatic grasp; intraoperative ureteral identification adjunct.
  • Transvaginal-mesh / sacrocolpopexy-mesh excision (robotic abdominal approach) — fine plane dissection between mesh and bladder / bowel / vagina.
  • Robotic VVF / ureterovaginal-fistula repair — fistula-tract delineation and tissue mobilization.
  • Robotic Bricker / Wallace ureteroenteric reconstruction at the time of revision diversion.
  • Robotic RP / RC reconstructive components — dorsal vein complex (DVC) control, posterior reconstruction, vesicourethral anastomosis preparation (NVB-sparing dissection).
  • Robotic vaginal-cuff / apical-prolapse repair — broad-ligament and uterosacral-ligament work.

Hemostatic Performance and Energy Settings​

  • Smaller-vessel control — bipolar through the Maryland reliably handles small arterial and venous branches and is more precise than monopolar cautery for bleeding control, though it does not replace clip ligation for larger vessels.[5]
  • Technique — maintain a small gap between the tips (not fully closed) for optimal current density, mirroring handheld bipolar technique.[5]
  • Common settings — 3 or 4 for both monopolar and bipolar; default cut mode (auto cut), default coagulation mode (forced coag).[5]

Thermal Spread​

  • Bipolar instruments at 60 W produce mean critical thermal spread ~ 2.2 mm at 1 s and 3.6 mm at 2 s — significantly less than monopolar.[6]
  • A second Maryland clamp can serve as a heat sink to further protect adjacent nerves (NVB, obturator, dorsal nerve of clitoris) during near-nerve coagulation.[6]

Maryland vs Other da Vinci Energy / Grasping Instruments​

InstrumentPrimary roleWhen to choose Maryland instead
Monopolar curved scissorsCutting + monopolar coagulation in the right handMaryland complements as the left-hand dissector
Fenestrated bipolar forcepsBroader flat backside for diffuse surface bleedingFenestrated better for diffuse hemostasis; Maryland for fine dissection[5]
Vessel sealer / SynchroSealSealing pedicles up to ~ 7 mmVessel sealer for larger vessels; Maryland for finer dissection
ProGrasp / Cadiere / Tip-UpAtraumatic retractionUse for retraction; Maryland for working dissection

Cross-Specialty Evidence Supporting the Maryland​

  • Robot-assisted mediastinal tumor resection (Hong 2023 thoracic) — Maryland vs electrocoagulation hook: shorter OR time, less bleeding, less drainage, shorter LOS, lower inflammatory markers (IL-6 / IL-8 / TNF-α / cortisol).[7]
  • TORS (transoral robotic surgery) — central dissection / hemostasis instrument on Si and SP systems.[4][5]
  • Robotic hysterectomy (Ochi 2024) — "double-bipolar method" uses Maryland as the primary incise / dissect / coagulate / grasp instrument, reducing instrument changes and cost.[1]
  • Robotic esophagectomy — accurate dissection with strong hemostasis; trade-off of repeated open/close motion may add operative time vs ultrasonic devices.[2]
  • Robotic hepatobiliary — right-angle dissector substitute for small-vessel pedicle dissection.[3]
  • Robotic thyroidectomy (trans-axillary / retro-auricular) — primary dissecting instrument.[8]

These cross-specialty signals translate directly to robotic urogyn / RU — the same dissection-plus-bipolar-hemostasis profile that suits mediastinal and thyroid plane dissection suits the broad-ligament, paravaginal, periureteral, and presacral planes.

Limitations​

  • Vessel-size ceiling — bipolar through fine tips handles small-to-moderate vessels; clip larger pedicles rather than rely on the Maryland alone.
  • Open-and-close motion to titrate energy can slow dissection vs continuous ultrasonic devices.
  • Thermal injury to adjacent nerves — respect 2–3 mm working distance from the NVB / obturator / dorsal NC; use a second Maryland as heat sink if necessary.
  • Single-arm constraint — when both hands need bipolar (rare), the fenestrated bipolar can substitute on the contralateral arm.

See also: Gerald Bipolar Forceps, Bovie Tips, Electrosurgical Pencil, Mixter Right-Angle Clamp, Gemini Fine Right Angle, DeBakey Forceps.

References​

1. Ochi Y, Andou M, Taniguchi R, et al. "Robot-assisted hysterectomy using the double-bipolar method." J Minim Invasive Gynecol. 2024;31(8):640. doi:10.1016/j.jmig.2024.03.013

2. Hirahara N, Matsubara T, Hayashi H, Tajima Y. "Features and applications of energy devices for prone robot-assisted minimally invasive esophagectomy: a narrative review." J Thorac Dis. 2022;14(9):3606–12. doi:10.21037/jtd-22-559

3. Magistri P, Guerrini GP, Ballarin R, et al. "Improving outcomes defending patient safety: the learning journey in robotic liver resections." Biomed Res Int. 2019;2019:1835085. doi:10.1155/2019/1835085

4. Tateya I, Koh YW, Tsang RK, et al. "Flexible next-generation robotic surgical system for transoral endoscopic hypopharyngectomy: a comparative preclinical study." Head Neck. 2018;40(1):16–23. doi:10.1002/hed.24868

5. Oberhelman N, Bruening J, Jackson RS, et al. "Comparison of da Vinci Single Port vs Si systems for transoral robotic-assisted surgery: a review with technical insights." JAMA Otolaryngol Head Neck Surg. 2024;150(2):165–71. doi:10.1001/jamaoto.2023.3994

6. Hefermehl LJ, Largo RA, Hermanns T, et al. "Lateral temperature spread of monopolar, bipolar and ultrasonic instruments for robot-assisted laparoscopic surgery." BJU Int. 2014;114(2):245–52. doi:10.1111/bju.12498

7. Hong Z, Bai X, Sheng Y, et al. "Efficacy of using Maryland forceps versus electrocoagulation hooks in da Vinci robot-assisted thoracoscopic mediastinal tumor resection." World J Surg Oncol. 2023;21(1):184. doi:10.1186/s12957-023-03065-y

8. Mohamed HE, Kandil E. "Robotic trans-axillary and retro-auricular thyroid surgery." J Surg Oncol. 2015;112(3):243–9. doi:10.1002/jso.23955