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Potts (Potts-Smith) Scissors

Angled, fine-bladed scissors designed for precise controlled cuts along tubular structures — the default scissor for extending an arteriotomy, urethrotomy, ureterotomy, or vasotomy in a clean, predictable line. The defining feature is the angled blade (25°, 45°, or 60°) that lets the cutting edge follow the long axis of the tubular structure while the surgeon's hand stays comfortable and the line of sight stays clear.[1][2]

Design​

  • Blade angle: blades set at 25°, 45°, or 60° to the handle axis. The 45° Potts is the daily workhorse for most open RU work; the 25° and 60° variants are reserved for specific anatomic geometries and surgeon preference.
  • Tips: fine, sharp — designed to incise the lumen of a vessel, ureter, or urethra without tearing the wall or traumatizing the adjacent mucosa.
  • Blade-to-handle ratio: short blades on long handles, similar to Metzenbaum — reach into the field with precision preserved at the tips.
  • Length: typically 18 cm (7 in) to 25 cm (10 in); micro-Potts variants for microsurgical and pediatric work are 14–16 cm.
  • Material: surgical-grade stainless steel.

Reconstructive-Urology and Urogyn Uses​

Extending a urethrotomy​

The most common RU use. A small initial urethrotomy is made with a #11 or #15 blade; the Potts is used to extend the urethrotomy proximally and distally along the urethra in a clean, predictable line — for:

  • Anastomotic urethroplasty — extending the urethrotomy at the proximal and distal ends to define the cut-back length for tension-free anastomosis.
  • Augmentation / substitution urethroplasty — extending the urethrotomy to receive a BMG or skin-flap onlay (TIP / TIPU / Mathieu / onlay-island-flap).
  • Posterior urethroplasty — extending the urethrotomy at the level of the stricture to define the spatulation lines.

Spatulating ureter and urethra for anastomosis​

  • Ureteral spatulation during ureteral reimplantation, ureteroureterostomy, ileal-ureter interposition, Boari-flap reconstruction, and trans-ureteroureterostomy — the Potts extends a small initial cut to a 6–10 mm spatulated end for a wide watertight anastomosis.
  • Urethral spatulation at the distal stump during posterior urethroplasty and at the apical stump during VUA / re-do VUA after radical prostatectomy.

Microsurgical vasovasostomy and vasoepididymostomy​

  • Vasal mucosal opening — a controlled angled cut to open the vasal lumen for the two-layer microsurgical anastomosis. The fine micro-Potts variant is preferred for this step.
  • Epididymal tubule opening for vasoepididymostomy.

Genital-vessel and microsurgical reconstructive work​

  • Vascular preparation during penile / genital replantation — recipient-vessel arteriotomy and venotomy for the microvascular anastomosis.
  • Microsurgical lymphovenous anastomosis (LVA) — opening recipient veins and lymphatics for the supermicrosurgical anastomosis during genital lymphedema work (LVA / VLNT / SCIP-LFT / CHASCIP).
  • Microvascular pedicle preparation for free flaps — RFFF / ALT / DIEP / TRAM recipient and donor vessel openings during phalloplasty and vulvar / pelvic free-flap reconstruction.

Mucosal trim and graft / flap shaping​

  • BMG and FTSG / STSG trimming to fit the urethrotomy — Potts cuts the graft edge cleanly without crushing the mucosa.
  • Flap-edge trimming during scrotal, vulvar, and perineal flap work.

Open vascular control during pelvic dissection​

  • Extension of an iatrogenic or planned venotomy during deep pelvic dissection (DVC tributaries, internal iliac branches) where a small controlled extension allows repair without enlarging the defect.

Technique​

  • Orient the angled blade so the cutting edge follows the intended line of the incision along the tubular wall. Choose the 25°, 45°, or 60° variant by what angle keeps the surgeon's hand outside the operative field.
  • Anchor with DeBakey thumb forceps — DeBakey holds the vessel / ureter / urethra wall on tension; Potts advances along the lumen.
  • Single decisive cuts, not multiple small bites — a stuttered Potts incision creates irregular edges that complicate anastomosis.
  • Keep dedicated to luminal work: never use Potts on suture, drains, or heavy connective tissue. Switch to Mayo or Metzenbaum for those layers.

Distinctions from Adjacent Scissors​

ScissorBladeTissueBest fit
PottsAngled (25 / 45 / 60°), fineVessel / ureter / urethra / vas wallExtending an arteriotomy / urethrotomy / ureterotomy / vasotomy
MayoStraight or curved, heavyFascia, mesh, suture, dressingsWorkhorse cut-and-divide
MetzenbaumStraight or curved, fineAreolar / fat / peritoneum / thin fasciaPelvic plane dissection
IrisStraight, short, fineGlanular skin, vasal mucosa, vesselsHypospadias / glansplasty / microsurgical
Castroviejo / microSpring-action, ultra-fineMicrosurgical layersVasovasostomy, LVA

Historical Context​

Named for Willis J. Potts (1895–1968), a pioneering pediatric cardiovascular surgeon at Children's Memorial Hospital in Chicago.[1][2] Potts is best known clinically for the Potts shunt — a side-to-side anastomosis between the descending aorta and the left pulmonary artery — first described in 1946 as a palliative procedure for tetralogy of Fallot in the pre-cardiopulmonary-bypass era; the shunt persists in modern pediatric cardiology as a treatment for refractory pulmonary hypertension.[3] The scissors that bear his name were designed to meet the precise demands of vascular and cardiac anastomoses, where controlled angled incisions along a vessel are the rate-limiting step. The instrument is often called Potts-Smith scissors, acknowledging his collaborator Sidney Smith.[1][2]

See also: Mayo Scissors, Metzenbaum Scissors, DeBakey Forceps, Gerald Forceps.

References​

1. Ailawadi G, Nagji AS, Jones DR. "The legends behind cardiothoracic surgical instruments." Ann Thorac Surg. 2010;89(5):1693–700. doi:10.1016/j.athoracsur.2009.11.019

2. El-Sedfy A, Chamberlain RS. "Surgeons and their tools: a history of surgical instruments and their innovators — part I: place the scissors on the Mayo stand." Am Surg. 2014;80(11):1089–92.

3. Grady RM. "Beyond transplant: roles of atrial septostomy and Potts shunt in pediatric pulmonary hypertension." Pediatr Pulmonol. 2021;56(3):656–60. doi:10.1002/ppul.25049