Uterine Tenaculum Forceps: Schroeder vs Duplay vs Jacobs

The cervix moves. That single fact explains why a tenaculum exists at all.

Anyone who has attempted a hysteroscopy on an anteverted uterus without stabilising the anterior lip knows the problem — the sound wanders, the cervical canal angles away from the instrument, and the false passage risk climbs. A vulsellum or tenaculum applied at 12 o’clock straightens the utero-cervical axis and converts a blind, mobile target into a fixed one.

But “tenaculum” covers a family of instruments with genuinely different jaw geometry, and the three patterns most hospitals stock — Schroeder, Duplay and Jacobs — are not interchangeable. Grabbing the wrong one costs you either grip or tissue.

What Separates the Three Patterns

All three are ring-handled, ratcheted grasping instruments in the 240–260 mm range. The difference lives entirely in the jaws.

The clinical shorthand: Schroeder and Duplay puncture. Jacobs grips without puncturing — its claws close on each other around tissue rather than through it.

Schroeder — the workhorse

Sharp single or double prongs, straight shafts, and a ratchet that holds under sustained traction. The 1×1 configuration causes the least trauma and is what most clinics use for IUD insertion and diagnostic hysteroscopy. The 2×2 and 3×3 profiles distribute load over more points and are the versions you want when hauling a fibroid uterus toward the incision during a total abdominal hysterectomy.

Bleeding from the puncture sites is real but usually self-limiting. Pressure for thirty seconds settles most of it; a figure-of-eight suture handles the rest.

Duplay — for the difficult angle

The Duplay’s S-shaped shaft is the whole point. On a sharply retroverted uterus, or when the vaginal introitus is narrow and a straight instrument forces the operator’s hand into the visual field, the offset lets you apply traction while keeping the line of sight clear. Single-toothed jaws mean one puncture point, not two.

It is a specialist instrument, and plenty of departments never stock it. Those that do tend to be running colposcopy and LLETZ lists where the angle problem shows up daily.

Jacobs — when you cannot afford a puncture

Also catalogued as a vulsellum in British usage, the Jacobs has blunt, fenestrated, interlocking claws. It grabs a substantial bite of tissue and holds it without perforating — which matters on friable postmenopausal cervix, on a soft postpartum uterus, and on myoma capsule during myomectomy where a sharp prong would simply tear out.

The trade-off is bulk. A Jacobs occupies more space in the vagina than a Schroeder and obstructs more of the operative field during vaginal procedures.

Choosing by Procedure

A practical mapping, based on how these instruments actually get requisitioned:

• IUD insertion / endometrial biopsy — Schroeder 1×1. Minimum trauma, adequate stabilisation.
• Diagnostic and operative hysteroscopy — Schroeder 1×1, or Duplay if the axis is hostile.
• Dilatation and curettage — Schroeder 1×1 or 2×2, applied to the anterior lip before sounding.
• Total abdominal hysterectomy — Schroeder 2×2 or 3×3 for uterine traction; Jacobs if the specimen is soft or the tissue is friable.
• Vaginal hysterectomy — Jacobs for the cervix, then Schroeder patterns for pedicle control.
• Myomectomy — Jacobs onto the myoma itself; a sharp prong shears through fibroid capsule under traction.
• Postpartum cervical repair — Jacobs or a ring forceps. Puerperal cervix tears under sharp prongs.

For a broader view of what else belongs on the tray alongside these, see our complete OB/GYN surgical instruments guide.

Application Technique

Where and how the instrument is applied determines whether it holds or tears out.

The anterior lip at 12 o’clock is the standard site for axis correction on an anteverted uterus. On a retroverted uterus the posterior lip at 6 o’clock is the correct application, and applying anteriorly on a retroverted uterus actively worsens the angle you are trying to fix — a mistake that produces most of the false passages seen during difficult sounding.

Bite depth matters. A shallow bite that catches only cervical mucosa will shear out under traction and bleed. The prongs should engage the fibromuscular stroma, roughly 5 to 8 mm in from the external os, applied perpendicular to the surface rather than obliquely.

Traction should be steady and axial. Sudden jerking traction is what tears cervix, particularly in postmenopausal tissue where the stroma is atrophic and the collagen less compliant. If a Schroeder repeatedly tears out on friable tissue, the answer is to switch to a Jacobs rather than to bite deeper.

Release the ratchet fully before withdrawing. Dragging a partially engaged jaw off the cervix extends the puncture into a laceration.

Material and Construction Standards

Uterine tenaculum forceps are almost always martensitic stainless — AISI 420 for the jaws and shanks, hardened and tempered so the prong tips resist blunting. Prong tips are the failure point: a rolled or flattened tip will not penetrate cervix cleanly, and the operator compensates with force, which is when tissue tears.

Manufacturing points worth specifying on a purchase order:

Box joint construction matters more here than on most instruments, because the loading is almost purely lateral — you are pulling, not squeezing. We covered the mechanics of this in box joint versus screw joint construction.

Inspection and Maintenance

Three checks before an instrument goes back into a set:

Prong tip integrity. Hold the closed jaw under a loupe. Sharp patterns should show a defined point, not a rounded shoulder. A blunted Schroeder is a tissue-tearing instrument, not a grasping one.

Ratchet hold. Close to the first tooth, then apply firm traction on the shanks. If it jumps, retire it. This failure is common and under-detected because it only manifests under load.

Jaw approximation. Close fully and hold to the light. Any visible gap at the tips on a Jacobs means the claws will not interlock and tissue slips out.

Blood in the box joint is the usual cause of stiffness. Ultrasonic cleaning with the instrument in the open position, followed by lubrication of the joint, resolves most cases — see our notes on instrument lubrication for the correct product and sequence.

Common Ordering Mistakes

Two recurring errors show up in tender documents that cross our desk.

The first is specifying only “tenaculum forceps, 25 cm” with no tooth profile. Suppliers then ship whatever is cheapest, which is usually 1×1 sharp — leaving the theatre without a blunt option for friable tissue.

The second is treating “vulsellum” and “tenaculum” as synonyms in a bill of quantities. In British and Commonwealth practice, vulsellum generally means the blunt-clawed pattern (Jacobs) and tenaculum the sharp-pronged one (Schroeder). In North American catalogues the terms blur. If your specification is going to a manufacturer in Sialkot or Tuttlingen, name the eponym and the tooth configuration explicitly — “Jacobs vulsellum, 3×3 blunt claw, 240 mm” leaves nothing to interpretation.

Fizza Surgical manufactures all three patterns across the standard tooth configurations. Full range on the surgical instruments category, and our manufacturing credentials on the certifications page.