Intracorporeal Needles

Laparoscopic intracorporeal needle configuration has received limited attention by manufacturers to date (156). Because of the limitations of the closed working environment and difficulty of intracorporeal suturing, it might be expected that needle configurations should approximate those of microsurgery. Needles should be high-quality stainless steel or carbon steel. Carbon steel needles are harder but are more brittle, and "on-table" adjustments could result in weakening or breaking of the shaft. Homogenous stainless steel is preferred but more costly. The needle profile of choice has not been rigorously investigated (146). In our study of intracorporeal bladder neck reconstructions, we identified three configurations that facilitated intracorporeal suturing (151). A curved 3/8 needle, a ski configuration, and an "S"-shaped profile were most helpful (Fig. 31). Needle points can be taper point, cutting, spatulated, or taper cut depending upon the tissue and resistance expected in suturing.

The spatial constraints limit the needle size, shape, and suture lengths needed to most expeditiously accomplish intracorporeal suturing. For urologic pelvic work on the urethra or bladder neck, the deep recesses of the retropubic space permit only a small 1/2 or 3/8 needle (RB-1 or TF) taper point configured needle to allow eversion of knots when reconstruction is performed. Some investigators have advocated straight needles (SC-1 Ethicon, TS-20 Davis & Geck, Endosutureā„¢ WISAP, or ELW U.S. Surgical). These have primary advantage on surface structures or when intracorporeal suturing with straight needle graspers.

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