Peer-Reviewed Evidence

Shira 3-Jaw Clamp vs Acland Clamp
A Clinical Comparison

Three independent studies — including a randomised controlled trial — demonstrate consistent, statistically significant superiority across every measured outcome.

0% Backwalling rate
p<0.001 RCT significance
0 Clamp flips required
3 Published studies
Evidence base
PRS, Oct 2022 · AIIMS New Delhi + U. Rochester JPRAS, Sep 2022 · AIIMS Jodhpur RCT · JPRAS, Dec 2023 · AIIMS Jodhpur + Apollo CBCC

Head-to-Head Results

Outcome Shira 3-Jaw Clamp Acland Clamp
Backwalling rate Inadvertent posterior wall suture capture 0% ✓ Best p=0.007 vs Acland · PRS 2022 30.8%
Clamp flips required Repositioning to access posterior wall 0 ✓ Best RCT confirmed · JPRAS 2023 Required for every case
Posterior wall visibility Visualisation without repositioning Full — all 360° accessible First clinical report · JPRAS 2022 Partial — flip required
Anastomosis time Total operative time for vessel join Significantly faster p=0.007 · PRS 2022 Longer
Patency rate Vessel remains open post-anastomosis 100% (lab) / Non-inferior (clinical) RCT · JPRAS 2023 Comparable
Overall RCT outcomes All primary endpoints in JPRAS 2023 RCT Superior — all outcomes ✓ Best p<0.001 · Randomised Controlled Trial Inferior on all endpoints
Intima damage risk Vessel wall trauma from instrumentation Reduced — 3-jaw even distribution Design advantage Standard 2-jaw compression

What the Evidence Shows

Independent research across three institutions, two journals, one RCT.

PRS · Oct 2022

0%

Backwalling — zero cases

Saha et al. (AIIMS New Delhi & University of Rochester) reported 0% backwalling vs 30.8% with Acland clamp (p=0.007) with significantly faster anastomosis times.

JPRAS · Sep 2022

360°

Full posterior wall visibility

Kohli et al. (AIIMS Jodhpur) published the first clinical report of the vessel-eversion design, confirming complete posterior wall visibility without any clamp repositioning.

JPRAS RCT · Dec 2023

p<0.001

Superior on all RCT outcomes

Kohli et al. (AIIMS Jodhpur + Apollo CBCC) conducted a randomised controlled trial confirming statistically significant superiority across all primary endpoints. Zero clamp flips required.

Why the 3-Jaw Design Works

Shira 3-Jaw Clamp

  • Three-jaw mechanism everts vessel wall, exposing lumen in all directions
  • Posterior wall always visible — no repositioning at any point
  • Backwalling mechanically impossible when used as designed
  • Even circumferential force distribution reduces intima trauma
  • Approximator function maintains vessel alignment throughout
  • One instrument, complete anastomosis — no workflow interruption

Acland Clamp

  • Two-jaw clamp cannot evert the vessel lumen
  • Posterior wall requires clamp flip to access
  • Flip creates risk of backwalling (30.8% in PRS study)
  • Repositioning adds time and manipulation to the anastomosis
  • Established gold standard — used globally for decades
  • Well-understood handling characteristics

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References

  1. Saha S, et al. "A comparative study of a novel 3-jaw microvascular clamp with the standard Acland clamp." Plastic and Reconstructive Surgery, Oct 2022. DOI: 10.1097/PRS.0000000000009530
  2. Kohli N, et al. "A novel 3-jaw microvascular approximating clamp." Journal of Plastic, Reconstructive & Aesthetic Surgery, Sep 2022. DOI: 10.1016/j.bjps.2022.06.068
  3. Kohli N, et al. "Randomised controlled trial comparing the 3-jaw microvascular clamp with the Acland clamp." Journal of Plastic, Reconstructive & Aesthetic Surgery, Dec 2023. DOI: 10.1016/j.bjps.2023.09.022