A scalpel, lancet, or bistoury is a small and extremely sharp bladed instrument used for surgery, anatomical dissection, podiatry and various handicrafts. A lancet is a double-edged scalpel.

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Scalpel

Various scalpels. The first (from left), second, and fourth have replaceable blades. The fifth is a lancet.
Classification	Cutting tool
Used with	Stencil, surgery
Related	Lancet, utility knife, laser scalpel

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Scalpel blades are usually made of hardened and tempered steel, stainless steel, or high carbon steel; in addition, titanium, ceramic, diamond and even obsidian knives are not uncommon. For example, when performing surgery under MRI guidance, steel blades are unusable (the blades would be drawn to the magnets and would also cause image artifacts). Historically, the preferred material for surgical scalpels was silver. Scalpel blades are also offered by some manufacturers with a zirconium nitride–coated edge to improve sharpness and edge retention. Others manufacture blades that are polymer-coated to enhance lubricity during a cut.

Scalpels may be single-use disposable or re-usable. Re-usable scalpels can have permanently attached blades that can be sharpened or, more commonly, removable single-use blades. Disposable scalpels usually have a plastic handle with an extensible blade (like a utility knife) and are used once, then the entire instrument is discarded. Scalpel blades are usually individually packed in sterile pouches but are also offered non-sterile.

Alternatives to scalpels in surgical applications include electrocautery and lasers.

Obsidian scalpels older than 2100 BC have been found in a Bronze Age settlement in Turkey.^[1] Skulls from the same time and place show signs of brain surgery.^[2]

Ancient Egyptians made incisions for embalming with scalpels of sharpened obsidian, a material that is still in use.

The first medical writings of ancient Greeks indicate they were commonly using tools identical to today's scalpels around 500 BC.^[3] The amphismela was an anatomical knife-edged on both sides. The term comes from the Greek αμφι (utrinque, "on both sides"), and μελιζω (inside, "I cut").^[4]

Ancient Romans used more than 150 different surgical instruments, including scalpels.^[5]

10th century Arab-Spanish surgeon Albucasis invented a retractable scalpel.^[6]

The French used an amphismela in the 1700s.^[7]

South African scientists showed that a blunt scalpel caused sharp cuts if the blade was subjected to ultrasound.^[8] Applications might be in energy-saving paper cutting.^[9]

In the palmar grip, also called the "dinner knife" grip, the handle is held with the second through fourth fingers and secured along the base of the thumb, with the index finger extended along the top rear of the blade and the thumb along the side of the handle. This grip is best for initial incisions and larger cuts.

In the pencil grip, best used for more accurate cuts with smaller blades (e.g. #15) and the #7 handle, the scalpel is held with the tips of the first and second fingers and the tip of the thumb with the handle resting on the fleshy base of the index finger and thumb.

The examples and perspective in this section deal primarily with the United States and do not represent a worldwide view of the subject. (January 2021)

Rising awareness of the dangers of sharps in a medical environment around the beginning of the 21st century led to the development of various methods of protecting healthcare workers from accidental cuts and puncture wounds. According to the Centers for Disease Control and Prevention, as many as 1,000 people were subject to accidental needle sticks and lacerations each day in the United States while providing medical care. Additionally, surgeons can expect to suffer hundreds of such injuries over the course of their career.^[11] Scalpel blade injuries were among the most frequent sharps injuries, second only to needlesticks. Scalpel injuries made up 7 percent to 8 percent of all sharps injuries in 2001.^[12][13]

"Scalpel Safety" is a term coined to inform users that there are choices available to them to ensure their protection from this common sharps injury.^[14]

Safety scalpels are becoming increasingly popular as their prices come down and also on account of legislation such as the Needle Stick Prevention Act, which requires hospitals to minimize the risk of pathogen transmission through needle or scalpel-related accidents.^[15]

There are essentially two kinds of disposable safety scalpels offered by various manufacturers. They can be either classified as retractable blade or retractable sheath type. The retractable blade version made by companies such as OX Med Tech, DeRoyal, Jai Surgicals, Swann Morton, and PenBlade are more intuitive to use due to their similarities to a standard box-cutter. Retractable sheath versions have much stronger ergonomic feel for the doctors and are made by companies such as Aditya Dispomed, Aspen Surgical and Southmedic. A few companies ^[who?] have also started to offer a safety scalpel with a reusable metal handle. In such models, the blade is usually protected in a cartridge. Such systems usually require a custom handle and the price of blades and cartridges is considerably more than for conventional surgical blades.

However, CDC studies shows that up to 87% of active medical devices are not activated.^{[clarification needed]} Safety scalpels are active devices and therefore the risk of not activating is still significant.^[16] There is a study that indicated there were actually four times more injuries with safety scalpels than reusable scalpels.^{[17][full citation needed]}

There are various scalpel blade removers on the market that allows users to safely remove blades from the handle, instead of dangerously using fingers or forceps. In the medical field, when taking into account activation rates, the combination of a single-handed scalpel blade remover with a passing tray or a neutral zone was as safe and up to five times safer than a safety scalpel.^[18] There are companies which offer a single-handed scalpel blade remover that complies with regulatory requirements such as US Occupational Safety and Health Administration Standards.^[19]

The usage of both safety scalpels and a single-handed blade remover, combined with a hands-free passing technique, are potentially effective in reducing scalpel blade injuries.^[18] It is up to employers and scalpel users to consider and use safer and more effective scalpel safety measures when feasible.

• Laser scalpel – Medical use of laser to cut tissuesPages displaying short descriptions of redirect targets
• Medical device – Device to be used for medical purposes
• The Lancet – Peer-reviewed general medical journal