The laparoscopic Deschamps needle: revival of an old concept

Abstract

Background In laparoscopic surgery there are several appropriate ways of securing uterine or ovarian vessels. The costs of stapling are high. Bipolar coagulation is a cheap and useful technique; however, it carries a risk of inadvertent heat conduction to neighbouring organs. Ligating the uterine pedicle may be a reasonable alternative, but stitching with a sharp needle may damage large arteries and can cause uncontrollable haemorrhage. Instrument In view of this, a laparoscopic needle similar to the Deschamps needle (with a blunt, articulating tip and a distal eye) has been developed. The needle is loaded with any regular suturing material. The instrument is introduced through an operation port of 5 mm or more. After the tissue that is to be transsected has been perforated by the Deschamps needle, a second needle-holder is introduced and both ends of the suture are pulled outside the abdomen. The knot is tied, using a Clarke knot-pusher. A total of four extra-abdominal throws strengthen the final knot. The threads are then cut. Results In a 24-month period we tested the device in 50 patients, who underwent a laparoscopically assisted vaginal hysterectomy (LAVH). In all patients the uterine vessels were ligated by Deschamps suturing; in seven the ovarian vessels were also ligated using this technique. Conclusion Suturing with the Deschamps needle is easy to learn, and is fast, effective and inexpensive.