A specially devised needle kit for laparoscopic repair of inguinal hernias with patent processus vaginalis.

Masao Endo, MD1, Hirofumi Tomita, MD1, Fumiko Yoshida, MD1, Miwako Nakano, MD1, Leonardo Ryou Igarashi2. 1Saitama City Hospital, 2Cosmic M.E. Inc.

Objective: We developed a unique technique to achieve completely extraperitoneal ligation of patent processus vaginalis (PPV) without any skip areas, sparing the spermatic cord and vessels (Surg Endosc, 2009), and the technique has been applied to more than 2,000 children with minimum recurrence rates (0.08%), and recently its application has been extended to adult cases.

  The key point of this technique is to usher a suture in and out around the internal inguinal ring (IIR) percutaneously under safe and precise control. We proposed an equipment for sending and retrieving the suture through extraperitoneal route to facilitate this procedure as an Endoneedle Kit at the Emerging Technology Poster Session (2009). The purpose of this paper is to introduce the improved device for commercial goods named EndoneedleNeo.

Technology: This needle kit consists of a puncture needle (16-G, 70 mm in length), a suture sender (18-G), which is a needle that sends a suture through the barrel of the puncture needle, as well as a suture retriever (20-G), a needle that catches the suture end using its loop and pulls back the suture. These three needles can be put together into an assembly with plastic grips and acts as a 3-stage rocket by pushing each grip forward sequentially.

  In actual procedure, the puncture needle passes through the skin along the lower half of the IIR, and projects into the abdominal cavity. A 2-0 suture is delivered through the puncture needle using the suture sender and placed in extraperitoneal space. Then, the puncture needle again passes along the upper half of the IIR. The suture retriever, set in the lumen of the puncture needle, catches the intra-abdominal end of the suture using its loop. Consequently, the suture encircles the IIR with both ends of the suture outside the body. The IIR is closed by tying the both ends of the suture.

Preliminary results: The procedures have been facilitated more satisfactorily with the EndoneedleNeo than previously devised equipments in terms of precise control and saving the operation time. During the procedures the combined grips serve to not only fix the needles in place, but also can be used as a handling grip.

Conclusions: Using this 3 stage-rocket style needle kit, surgeon can perform all of the procedures, including sending and retrieving a suture around the IIR, with a single tool in hand, and can facilitate the operation smoothly resulting in saving the operation time. This kit can reduce the strain for both the surgeon and the affected patients during herniorrhaphy. 

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