Uterine closure with the endo stitch 10-mm laparoscopic suturing device--a review of 50 laparoscopic myomectomies
N H Stringer1, M A McMillen, R L Jones
1The Department of Obstetrics and Gynecology, Columbia Michael Reese Medical Center, Chicago, Illinois 60616, USA.
Objective:
To evaluate the mechanical performance of the Endo Stitch Laparoscopic Suturing Device and the clinical effectiveness of both a running, locked suture technique and a new modified suture technique for closure of uterine defects after laparoscopic removal of myomas.
Study Subjects:
Fifty consecutive patients with symptomatic uterine leiomyomata. OBSERVATIONAL METHOD: Retrospective chart review.
Main Findings:
The endometrial cavity was entered and sutured laparoscopically, in two layers, in 22 patients. In 28 patients, only the myometrium was sutured. A two-layered closure of the endometrium and myometrium was completed in an average time of 10 minutes. Mechanical problems with the Endo Stitch occurred in 11 cases. In all patients with second-look laparoscopies, the fallopian tubes were patent bilaterally without adhesions. No uterine fistulas were present in any patients with second-look laparoscopies. Posterior myomas were removed and sutured without adhesion formation. Grade 3 adhesions, to the uterine surface, were associated with transverse incisions of the uterus and over-treatment with GnRH analogs.
Conclusions:
The Endo Stitch Laparoscopic Suturing Device in combination with a running, locked suture technique achieves a rapid, hemostatic, clinically secure closure of the endometrium and myometrium. The Endo Stitch and our modified suture technique were not associated with adhesions or blockage of the fallopian tubes or uterine fistulas following laparoscopic myomectomies. The initial mechanical problems with the Endo Stitch were resolved. In our experience, currently the Endo Stitch is the best instrument for laparoscopic suture closure of uterine defects.
