Broken needle tip in Cooper's ligament: high occurrence rate with the EndostitchTM suturing device

Objective

To study the frequency of needle breakage with the Endostitch^TM needleholder while performing Burch laparoscopic colposuspension, and its consequences for patient and doctor.

Design

A retrospective observational multicentred study, after selection of the centres by questionnaire.

Setting

Three general hospitals in the Netherlands with resident training facilities and special interest in endoscopic surgery.

Subjects

35 consecutive patients with genuine stress incontinence.

Intervention

Laparoscopic Burch colposuspension using the Endostitch needleholder.

Main outcome measure

Needle complications and postoperative recovery.

Results

In five patients (14%) six needles broke off in the Cooper's ligament. Four needle tips in three patients could not be located despite dissecting the ligament and intensive search, and were ultimately left in the patients. The recovery of all patients with and without needle complications was uneventful.

Conclusions

The Endostitch is designed for intracorporeal suturing and knot tying, but because of its shape it is not suited for suturing Cooper's ligament. Mesh stapling techniques save operating time, but result in foreign (mostly non-absorbable) material being left in the patient and the stability of the suspension in the longer term is not yet established. At the present time, conventional suturing and knot tying seem to be preferable in laparoscopic suspension procedures, as they lead to more similarity between the laparoscopic method and the ‘open’ approach whose efficacy is well accepted.