The history and evolution of surgical instruments. VII. Spring forceps (tweezers), hooks and simple retractors.

Instruments manufactured by bending a basic metal strip or rod, either about its middle to create spring forceps (tweezers), or towards one extremity to create hooks and retractors are related structures. Spring forceps depend on tension mediated at the bend (hoop) or fixed end which is transmitted as dynamic 'spring' to the jaws, whereas the bend of hooks and retractors remains fixed and static. If such instruments refine the digital postures of pinch, pincer and retraction during surgery, they have not supplanted these manual actions entirely. After a brief historical introduction, the structure, modifications, functions and controls of spring forceps are analysed. Importantly, this instrument enjoys both right and left-handed functions, some of which are ancient, some transient as haemostats and needle-holders, and some, including left-handed dissection, surprisingly recent. Hooks are sharp or blunt and, among other functions, pre-date the left-handed spring forceps for dissection; in general hooks function as retractors. Hand-held retractors are enlarged blunt hooks, the wide retracting contact surface reducing trauma to wound margins and viscera. The physical effort of employing these retractors deep in body cavities is abated by applying them autostatically around a square or circular frame.