Millin Ligature-Carrying Forceps — Retropubic Prostatectomy

Millin Ligature-Carrying Forceps — Retropubic Prostatectomy

The Millin ligature-carrying forceps is the companion instrument to the Millin retropubic-prostatectomy approach — specifically designed to carry haemostatic sutures around the dorsal venous complex of the prostate at the start of the procedure. The dorsal venous plexus (Santorini’s plexus) is the major source of intra-operative bleeding during retropubic prostatectomy; controlled ligation at the procedure’s start prevents the catastrophic blood loss that uncontrolled venous bleeding produces.

The dorsal-venous-complex ligation

Terence Millin’s contribution to retropubic prostatectomy included the systematic ligation of the dorsal venous complex before any prostatic dissection — converting the procedure from a bloody enucleation to a controlled anatomic dissection. The Millin ligature-carrying forceps passes a heavy ligature (typically 0 or 1 chromic catgut) around the complex; the ligature is then tied and the prostatic capsule incised distal to the ligature.

The Walsh modification

Patrick Walsh’s 1982 anatomic radical prostatectomy refined the dorsal-venous-complex ligation technique that Millin had pioneered, enabling the nerve-sparing prostatectomy that preserves erectile function. The Millin ligature-carrying forceps remains in modern open radical prostatectomy practice for this critical haemostatic step.