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Tip-Up Fenestrated Grasper (da Vinci)

8 mm non-energized EndoWrist grasper with fenestrated jaws whose tips angle dorsally when closed — a scoop-like profile that slides under tissue planes and lifts structures upward. The retraction instrument of choice when the desired vector is perpendicular to the instrument shaft rather than parallel pulling — particularly useful for liver, bowel, sigmoid, and uterine lifting that complements the parallel-traction profile of the ProGrasp. Non-energized, low-cost, atraumatic.

Design​

  • Upward-angled jaw tips create a scoop / hook profile that lifts tissue rather than pulling it.
  • Fenestrated jaws — Brown 2014 bench data show fenestrations meaningfully improve grip when the surface-contact-to-fenestration area ratio exceeds 1:0.4.[1]
  • No electrical energy — purely mechanical.
  • EndoWrist 7 DoF articulation.[2]
  • 8 mm Si / Xi.

Grip-force profile​

The fenestrated-grasper family registers the lowest grip force of EndoWrist instruments in Mucksavage 2011 (2.26 ± 0.15 N for the double-fenestrated grasper, vs 39.92 ± 0.89 N for the Hem-o-lok clip applier).[3] Lee 2015 also showed grip-force varies 1.84–3.37× with EndoWrist articulation angle for the same surgeon input — important when retracting fragile structures.[4]

Practical implication: gentle, atraumatic retraction by design — trades absolute hold strength for tissue-friendliness.

Reconstructive-Urology and Urogyn Uses​

The Tip-Up fenestrated grasper is the scoop-and-lift retraction instrument in the robotic urogyn / RU portfolio:

  • Robotic sacrocolpopexy — scooping the sigmoid mesentery cephalad to clear the promontory; lifting the vaginal vault for paravaginal-tunnel exposure; uterine-fundus retraction in uterine-preserving sacrocolpopexy.
  • Robotic ureteral reimplant / Boari flap / psoas hitch — bladder-dome lift to access the trigone and reimplant site without crushing the bladder wall.
  • Robotic transvaginal-mesh excision — atraumatic scoop under mesh-covered bowel adhesions during dissection.
  • Robotic VVF / ureterovaginal-fistula repair — bladder and vaginal-wall lift for fistula-tract delineation.
  • Robotic radical prostatectomy reconstructive components — bladder-base lift for posterior reconstruction.
  • Robotic renal surgery — kidney lift to expose the hilum, particularly when a posterior approach to the renal vessels is needed.

ProGrasp vs Cadiere vs Tip-Up — When to Choose Which​

InstrumentEnergyGeometryRetraction vectorBest fit
ProGraspNoneBroad atraumatic teethParallel pullSustained tension; bladder-dome / Foley traction
CadiereNoneBroad fenestratedParallel pull / broad graspGeneral atraumatic grasping
Tip-Up FenestratedNoneFenestrated, tip-up scoopPerpendicular liftScoop-and-lift retraction (liver, sigmoid, bladder dome)
Fenestrated bipolarBipolarBroad fenestratedParallel pull + coagRetraction with diffuse hemostasis

The Tip-Up is the specialty pick when the retraction maneuver requires upward lift — the parallel-pull profile of ProGrasp / Cadiere does not substitute equally well.

Cross-Specialty Patterns​

  • Robotic colorectal (Pappou 2015 left / sigmoid colectomy setup) — third-arm retraction of omentum and small bowel; Tip-Up Fenestrated can substitute for ProGrasp / Cadiere when the lift vector is needed.[5]
  • Robotic hepatobiliary — the Tip-Up scoop is especially useful for liver lift to expose hiatus / porta hepatis (Tolboom 2015, Jain 2024) — substitutes for ProGrasp where the upward vector matters.[6][7]
  • Robotic gynecology — uterine manipulation and retraction during hysterectomy and other pelvic procedures (Lim 2017).[8]
  • Robotic urology — fourth-arm renal / bladder retraction (Rogers 2009, Esposito 2005).[9][10]

Practical Considerations​

  • Lift vector is the defining advantage — choose Tip-Up over ProGrasp when the retraction motion is perpendicular to the instrument shaft (eg, lifting the bladder dome off the trigone or the sigmoid off the promontory).
  • Lower grip force means the Tip-Up is less reliable for sustained high-tension retraction — switch to ProGrasp or Force Bipolar when sustained heavy traction is needed.
  • No haptic feedback on the da Vinci platform — tension is visual only (Johnson 2014, Wottawa 2016 in animal models).[11][12]
  • Non-energized → lower disposable cost vs the bipolar instruments.

Limitations​

  • Low grip force — not a substitute for ProGrasp / Force Bipolar when sustained heavy traction is required.
  • 8 mm port — same crowding considerations in narrow corridors as other 8 mm instruments.
  • No energy — companion instrument needed for hemostasis.
  • Tip-up geometry is not always advantageous — for parallel-traction maneuvers, ProGrasp or Cadiere is equivalent or better.

See also: ProGrasp, Maryland Bipolar, Fenestrated Bipolar, Force Bipolar.

References​

1. Brown AW, Brown SI, McLean D, Wang Z, Cuschieri A. "Impact of fenestrations and surface profiling on the holding of tissue by parallel occlusion laparoscopic graspers." Surg Endosc. 2014;28(4):1277–83. doi:10.1007/s00464-013-3323-7

2. Stafford AT, Walsh RM. "Robotic surgery of the pancreas: the current state of the art." J Surg Oncol. 2015;112(3):289–94. doi:10.1002/jso.23952

3. Mucksavage P, Kerbl DC, Pick DL, et al. "Differences in grip forces among various robotic instruments and da Vinci surgical platforms." J Endourol. 2011;25(3):523–8. doi:10.1089/end.2010.0306

4. Lee C, Park YH, Yoon C, et al. "A grip force model for the da Vinci end-effector to predict a compensation force." Med Biol Eng Comput. 2015;53(3):253–61. doi:10.1007/s11517-014-1230-2

5. Pappou EP, Weiser MR. "Robotic colonic resection." J Surg Oncol. 2015;112(3):315–20. doi:10.1002/jso.23953

6. Tolboom RC, Broeders IA, Draaisma WA. "Robot-assisted laparoscopic hiatal hernia and antireflux surgery." J Surg Oncol. 2015;112(3):266–70. doi:10.1002/jso.23912

7. Jain AJ, Newhook TE, Lilley E, et al. "A practical guide to inflow control, retraction, and exposure for robotic hepatectomy." Ann Surg Oncol. 2024;31(3):1833. doi:10.1245/s10434-023-14593-y

8. Lim PC, Kang E. "How to prepare the patient for robotic surgery: before and during the operation." Best Pract Res Clin Obstet Gynaecol. 2017;45:32–47. doi:10.1016/j.bpobgyn.2017.04.008

9. Rogers CG, Laungani R, Bhandari A, et al. "Maximizing console surgeon independence during robot-assisted renal surgery by using the fourth arm and TilePro." J Endourol. 2009;23(1):115–21. doi:10.1089/end.2008.0416

10. Esposito MP, Ilbeigi P, Ahmed M, Lanteri V. "Use of fourth arm in da Vinci robot-assisted extraperitoneal laparoscopic prostatectomy: novel technique." Urology. 2005;66(3):649–52. doi:10.1016/j.urology.2005.03.061

11. Johnson PJ, Schmidt DE, Duvvuri U. "Output control of da Vinci Surgical System's surgical graspers." J Surg Res. 2014;186(1):56–62. doi:10.1016/j.jss.2013.07.032

12. Wottawa CR, Genovese B, Nowroozi BN, et al. "Evaluating tactile feedback in robotic surgery for potential clinical application using an animal model." Surg Endosc. 2016;30(8):3198–209. doi:10.1007/s00464-015-4602-2