The laparoscopic Deschamps needle: revival of an old concept

Background In laparoscopic surgery there are several appropriate ways of se curing 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 pe dicle may be a reasonable alternative, but stitching with a sharp needle ma y 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 i s introduced through an operation port of 5 mm or more. After the tissue th at is to be transsected has been perforated by the Deschamps needle, a seco nd needle-holder is introduced and both ends of the suture are pulled outsi de the abdomen. The knot is tied, using a Clarke knot-pusher. A total of fo ur extra-abdominal throws strengthen the final knot. The threads are then c ut. Results In a 24-month period we tested the device in 50 patients, who under went a laparoscopically assisted vaginal hysterectomy (LAVH). In all patien ts the uterine vessels were ligated by Deschamps suturing; in seven the ova rian vessels were also ligated using this technique. Conclusion Suturing with the Deschamps needle is easy to learn, and is fast , effective and inexpensive.