The artery forceps
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(Left) Artery forceps: steel; 19th century; 2,1x14,2x5cm; Galante (Middle) Artery forceps: steel; 19th century; 4,2x12,2x5cm; Galante (Right) Artery forceps: steel; 19th century; 2x13,3x5,7cm; Galante |
The advantages of this instrument were considered, in the first place, for the arterial hemorrhages.
The process was been given several names. Verneuil had denominated it "forcipressure" (1875), Péan preferred "pincement" (1874). It appears to be Koeberlé who named it "pinces hemostatiques" (1868).
In the latest 18th century, the ligature discredit increased investigations on the creation of a more adjust forceps to surgical demands. Countless descriptions of instruments were made claiming for priority. Surgeons began to note that the forceps was an instrument of precious help in surgeries and that it could supplant the insufficiency of other hæmostatic agents.
The artery forceps closest precursors appeared in the latest 18th century and most of them had a short life. In 1787 Desaut (1744-1795) used two little fragments of wood, placed them under and on the vascular injury, and fixed them with a thread. Later, Percy used lead blades. The first arterial compressors with the shape of forceps appeared 20 years later, after the unsuccessful attempts of Desaut and Percy. Duret in his inaugural thesis "Sur la compression immédiate des artères dans l'opération de l'aneurisme" (1810) describes the aneurismal forceps. In 1811 appeared the Assalini's (1759-1849) artery compressor, the single one that has disseminated. Ristelhueber presents to the Medical Society of Strasbourg in 1817, instruments to be applied to hæmostasis, including his own and Sir Hernry's compressors. However, as Pierre Augustin Bérar (1785-1825) has stated, these instruments caused violent irritations to wounds, ulcerated the vessels and impeded a complete cicatrisation. New models were manufactured only some time later: Estrange, Lofflwer, Deschamps, Ayer. The last two, by their shape and construction resembled tourniquets.
The type of blood vessels and surgical performance were the caused the onset of new inventions. Diefenbach's forceps for venous hemorrhages was an example of the first case; Foulquier's tourniquet, Galiay's forceps, Hesselbach's forceps, Dupuytren's forceps and Henneman's forceps for hemorrhages in the skull trepanation, for the palm of the hand, for the epigastric and lithotomy and in therapeutics with leeches respectively, were examples of the second case.
If we consider the hæmostatic method in general, regardless the nature of the blood vessel or performed surgery, this process was associated to three distinct situations: in the course of an surgical performance was a temporary hæmostasis; when it conditioned the forceps permanence after the surgery until the complete obliteration of the vessel was an definitive hæmostasis; if it was aimed to thin tissues in order to obstruct the blood flux during the operation was an preventive hæmostasis.
The temporary hæmostasis began to be applied to all surgical performances since 1824. The instruments that were used seldom had the required solidity and simplicity, but all of them responded to the same need. In this respect we should mention Hanneman and Graefe's forceps, The Vidal the Cassis' (1803-1856) thin saws, Dieffenbach (1792-1860) and Sedillot's strong saws, according to the principle of Charrière, and the screw (Galaliay and Hesselbach) and ring saws.
The definitive hæmostasis was approached by Nunneley de Leeds (1867) when he asserted the need of a forceps with the following characteristics: thin, in order not to impede the junction, strong, in order to close hermetically the vessels without ulcerating or gangrening the walls and to be fixed wherever it was placed, and finally light. However his forceps were not sufficient to obstruct large vessels and aneurisms. The instruments made in England between 1867-72 applied the principles of Nunneley (Wolef, Taylor and Richardson's examples).
The artery forceps differs from the tweezer because it remains close through a special artifice. It was conceived several mechanisms: ring shaped, with grooves, with several rings and grooves, cross-harms, screw, among others.
The chances that improved the surgical practice were due to Joseph Frederic Charrière (1803-1876), an recognized manufacturer of surgical instruments, which resulted in a better hæmostasis. In 1858 Charrière conceived a ring forceps of continuous pressure based on another of his anatomy arsenal. Simultaneously Koeberlé, in 1865, directs the manufacturer called Elser in the manufacture of a similar forceps, and in 1868 Guéride, another instruments' manufacturer constructed, under the direction of Péan, a similar forceps of the previous ones. This forceps differed in the transversal racks. Later, Péan introduced various forms in the anterior extremity of the forceps. Koeberlé and Péan were very insistent claiming for the right of this invention. Charrière produced the articulation between the two branches of the forceps that allow the total separation after a 90º opening. The principle that underlines the Dieffenbach's forceps or bulldog - cross-branches was presented by the first time by Charrière in another instrument (1840). In 1874, Spencer Wells produced a forceps that have replaced Robert Liston's bulldogs and forceps. Collin had also started some changes in the articulation. The bases for the current artery forceps were created, a method of easy use, safe and that minimized haematic loss and the amount of time spent in a surgery.
Regarding the material chosen for the manufacturing of vascular compressors and since 1884(93, after the triumph of the concepts of Lister and Pasteur (antisepsis / asepsis) and stainless steel from 1925 - materials that resisted better the processes of disinfection and sterilization.
