"Rod manipulation with a vise-grip for larger deformity." The vise-grip allows a stronger manipulation of the rod, which is often needed in larger deformities. It can also allow for a CD rod-derotation maneuver. Notice that the rod has almost completely disappeared from the picture. Usually the rod is longer than needed, and at this point, can be cut to appropriate length. Also notice the sagittal contour of the rod has been appropriately maintained. The extra open MIS connectors used here are an occasional variation in technique.
Sarwahi et al. Scoliosis 2011 6:16 doi:10.1186/1748-7161-6-16