Practical Tips for Needle Introduction in Laparoscopy

Abstract

Study Objective The objectives for this video are 1) to provide an overview of common suture and needle types that are used in gynecologic laparoscopy and 2) to present various strategies to introduce different needles into the abdomen. Design In this video, we discuss approaches to introducing the needle into the abdomen during laparoscopy. The needle can generally be introduced either vaginally or abdominally. Setting During laparoscopy, all patients were positioned in dorsal lithotomy and in Tredelendburg position for the needle introduction process. Patients or Participants N/A Interventions N/A Measurements and Main Results In order to maintain small incisions while introducing a needle for suturing, one must have an understanding of the various needles, trocars, and techniques that can be used to introduce them. Abdominal introduction can further be subdivided into direct trocar entry, backloading the needle, and skiing the needle techniques. Direct trocar entry is dependent on the size of the needle and the diameter of the trocar. Backloading and skiing the needle are techniques that can be used when there is a need to pass a needle through a smaller trocar, for example when using 5 milimeter trocars. Generally, the 5 milimeter trocar will only be able to directly accommodate a Keith needle. Conclusion For laparoscopic procedures such as hysterectomy, needle introduction is the first step in the suturing process and familiarly with needle types, trocar size, and introduction techniques can assist with surgical efficiency.