Maryland Bipolar Forceps (da Vinci)
Maryland bipolar forceps combine a curved dissecting tip, grasping and bipolar coagulation. They are commonly paired with scissors or another grasper, but the working hand and arm arrangement depend on the procedure and surgeon. They do not have the integrated cutter or validated vessel capacity of a dedicated vessel sealer.
Platform and Design
- The current manufacturer portfolio lists the baseline multiport Maryland as an 8 mm instrument; distinguish it from the separate 5 mm Single-Site Maryland product.[1]
- SP Maryland instruments are separate products, including updated wrist and extended-range versions in FDA K241814. They are not interchangeable with an X/Xi instrument.[2]
- Da Vinci 5 also supports specifically identified force-feedback instruments. Check the part number, system, energy generator, compatible controls and remaining use life rather than transferring specifications between generations.[1]
The X/Xi manual lists the 5 mm Single-Site Maryland and fenestrated bipolar as single-use; these are distinct from reusable baseline EndoWrist and SP instruments.[4]
The curved tip can help develop a visible tissue plane or pass around an isolated structure. It does not make direct ureteral or neurovascular grasping atraumatic, and it should not be treated as equivalent to handling a vessel loop.
Reconstructive Applications
The Maryland is a common dissecting instrument for the surgeon's left-hand arm, paired with monopolar curved scissors on the right. The EndoWrist wrist lets the fine curved tip work like a right-angle dissector in tight planes. Typical reconstructive uses:
- Robotic sacrocolpopexy: promontory exposure, peritoneal incision and development of the vaginal tunnel.
- Ureteral reconstruction (reimplantation, Boari flap, psoas hitch, ureteroureterostomy): mobilization of the ureter and bladder.
- Mesh excision and fistula repair: fine plane dissection between mesh or fistula tract and the bladder, bowel or vagina.
- Revision diversion: ureteroenteric dissection at the time of Bricker or Wallace revision.
- Apical and cuff work: broad-ligament and uterosacral dissection.
Preserve the periureteral and flap blood supply and avoid grasping or heating structures merely because the tips can reach them. Use cold dissection, clips or sutures when they better protect the intended repair. Bipolar coagulation through the fine tips suits small vessels; clip or seal larger pedicles.
| Task | Selection consideration |
|---|---|
| Fine curved-tip dissection with selective coagulation | Maryland may provide a suitable shape and reach. |
| Broad retraction | Fenestrated bipolar or another grasper may offer a different tissue purchase; traction remains potentially injurious. |
| Temporary stronger grip plus coagulation | Force Bipolar provides selectable grip modes on compatible systems. |
| Pedicle sealing and division | Use the appropriate vessel sealer, clip or ligature. SynchroSeal is limited to 5 mm and VSE to 7 mm; neither limit belongs to Maryland forceps. |
Activation and Thermal Safety
Use the exact instrument and generator instructions. A numeric setting such as “3 or 4” or a named monopolar waveform is not a universal Maryland bipolar protocol. The X/Xi manual specifically addresses thin tissue: if opposing jaws touch and coagulation fails, slightly reopen and then reclose during activation. This is troubleshooting for the described device, not a reason to maintain a fixed gap in every application.[4] Automatic energy controls differ by system and do not prove that all captured tissue has a secure vascular seal.
Bipolar current is concentrated between the jaws, but heat can spread beyond them and remain after activation. The frequently quoted 2.2 and 3.6 mm values came from a particular bovine-tissue experiment at specified durations and power, using a selected temperature threshold. They are not validated nerve- or ureter-safe working distances.[3]
That experiment also evaluated a metal instrument as a heat sink. It does not establish a routine clinical maneuver for protecting nerves. Do not deliberately contact an energized instrument with another metal instrument without explicit compatible-device instructions; unintended electrical coupling is a separate hazard. Keep the target and working end visible, limit activation to the tissue intended for treatment, and consider nonthermal dissection near vulnerable structures.
Evidence Limits
Technique descriptions from thyroid, thoracic or abdominal surgery illustrate possible handling patterns; they do not establish better continence, fistula closure, nerve preservation or ureteral outcomes. Instrument selection should remain task-specific, and clinical results should not be inferred from tip shape alone.
See also: Energy Devices, Monopolar Curved Scissors, Gerald Bipolar, Mixter Right-Angle Clamp.
References
1. Intuitive. Da Vinci energy instruments and platform compatibility. Current manufacturer information; energy portfolio, baseline 8 mm instruments. Accessed September 2026.
2. US FDA. Da Vinci SP Instruments, K241814. November 18, 2024. Device summary and instrument tables.
3. 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;114:245–252. doi:10.1111/bju.12498.
4. Intuitive. Da Vinci Xi and X Instruments and Accessories User Manual, 553873-07 Rev. D. Chapter 8. Manufacturer manual.