Needle Holders

  • designed to securely hold and manipulate needles and the ends of suture material

Goal

  • efficient use of needle holders while suturing (minimizing number of motions necessary to position, insert and extract the needle and tie a secure knot)

Skills to Practice

  1. holding needle holders with a wide-based tripod grip
  2. quick controlled opening and closing of locking mechanism
  3. controlled and smooth insertion and extraction of needle in the tissues (lab 3)
  4. secure, repeatable square knot formation using needle drivers (lab 2)
  5. efficient use of needle holders while suturing (minimizing number of motions necessary to position, insert and extract needle, tie a square knot)

Basics

Needle Holder Parts

  • most have ringed handles and a ratchet locking system
  • jaws are wider and shorter than hemostats
  • prone to wear because of frequent use of a variety of needle sizes (needle slips or rotates when inserted into the tissues)

Tungsten-carbide tips available for some designs

      • strong metal insert with fine cross striations
      • reinforces the tips so they last longer and securely hold a wider range of needle sizes

Needle holders

  • various designs and sizes

Needle Holders Mayo-Hegar needle holder Mayo-Hegar needle holder Olsen-Hegar needle holder Olsen-Hegar needle holder

  • selection varies with intended use and surgeon preference
    • size selected for needle and suture material
      • large needle damages fine tips
      • large tip bends or breaks fine needles
    • length of handle used varies with location and depth of suturing

Mayo-Hegar Needle Holder

Needle Holders

  • short, strong jaws
  • securely grasps variety of needle sizes
  • durable
  • comes in a variety of sizes

Olsen-Hegar Needle Holder

Needle Holders

  • combines needle holder and suture scissors
  • suture can be placed and cut without changing instruments
  • useful for surgeons operating alone
  • combination tip is less durable across range of needle sizes
  • can inadvertently cut the suture

Holds

There are four holds for needle holders:

Wide-based tripod grip Wide-based tripod grip
Wide-based tripod grip Pencil Grip

Wide-based tripod grip

Wide-based tripod grip

  • Standard grip
  • tips of the thumb and ring finger are placed in rings
  • middle finger placed on top of finger ring
  • index finger is placed along the handle towards the fulcrum to stabilize the tips
  • wrist rotation used to drive needle through tissues
  • grip provides excellent precision
  • minimal movement of needle and instrument when jaws opened
  • recommended for novice surgeons

Wide-based tripod grip

Modified thenar-eminence grip

Wide-based tripod grip

  • ring finger placed through one ring
  • other ring rests on fleshy pad at base of thumb (thenar eminence)
  • wrist used to drive needle through tissues
  • grip facilitates rapid needle grasping
  • associated with some needle motion as needle released
  • typically used for rapid continuous patterns when precise needle release is less critical
  • some do not distinguish between this grip and palm grip

Palm grip

Wide-based tripod grip

  • fingers not placed through rings
  • handles are held in the palm
  • arm and wrist used to drive needle through tissues
  • produces a strong force to drive needle through tough tissues
  • less efficient and precise
  • most use only when necessary

Pencil grip

Pencil Grip

  • for use with specialized needle holders (e.g. Castroviego (shown above))
  • requires spring locking mechanism
  • provides most precise control of needle movement
  • finger generates force to drive needle (not wrist or arm)
  • use resticted to fine suturing (e.g. opthalmologic, microvascular)

How to Use

  • needle is grasped perpendicular to the jaws
  • placement of needle in the jaws varies with tissue thickness and density
    • grasp near the center of the curve for most situations
    • grasp near tip if penetrating tough tissue
    • grasp near eye or swedged-on end if large amount of tissue to penetrate
  • rotating the wrist while the needle is penetrating the tissue uses the arc of needle so less force is needed

  • needle is extracted from tissues with needle holders if it can be regrasped in a position suitable for inserting the next bite
  • if not enough needle exits the tissues, it can be extracted with tissue forceps
  • fingers should NOT be used
  • also used to form and tighten knots
    • only the ends of the suture are used grasped to avoid damage to the main strand

Skills to Master

  1. holding the needle drivers with a wide-based tripod grip
  2. quick, controlled opening and closing of the locking mechanism
  3. smooth insertion and extraction of the needle in the tissues
  4. secure, repeatable square knot formation using needle drivers (see lab 2)

Goal

  • efficient use of the needle holders while suturing (minimizing the number of motions necessary to position, insert and extract the needle, tie a square knot)

Practice:

  1. open and close needle holders using wide based tripod grip
  2. insert and extract needle from "tissues" (e.g. towel, foam)
  • position center of needle arc in tip of jaws
  • close ratchet mechanism 1 click
  • place needle tip at desired insertion site
  • rotate wrist to insert needle until approximately half of needle exits at desired location
  • release the needle
  • regrasp needle with needle holders in the centre of needle arc
  • tissue forceps can be used to help extract the needle if necessary. Don't use your fingers.