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Heaney Stitch

The Heaney stitch is a transfixing pedicle suture-ligature used in hysterectomy, particularly for a clamped uterosacral pedicle. A Heaney-type transfixion suture can serve as a pedicle ligature or, in Cruikshank's described vaginal-hysterectomy training technique, as a second tie after a simple uterine-vessel ligature; he also considers a single-clamp, single-suture method adequate.[4] It is associated with Noble Sproat Heaney and the instruments bearing his name.[1][2]

Technique​

  • Identify and protect nearby structures, especially the ureter, while placing a Heaney or suitable pedicle clamp close to the uterus; divide the pedicle on the specimen side.
  • For a selected uterosacral pedicle, pass a suture near the clamp tip and through the pedicle midportion, then tie and tag it (for example with a Kocher clamp) for later cuff support where applicable.[1] In the Atlas of Pelvic Surgery cuff-fixation technique, an absorbable suture passes from inside the ligament near the clamp tip out through vaginal mucosa, then returns through mucosa and the ligament midportion beneath the clamp to plicate the pedicle to the cuff.[2]
  • In the cited vaginal-hysterectomy sequence, the vascular cardinal pedicle receives a simple suture ligature without a fixation stitch because of hematoma concern. The tubo-ovarian–round-ligament pedicle receives a separate fixation ligature after a simple tie.[2]

The two passes, one at the clamp tip and one through the pedicle midportion, distinguish the described Heaney-type stitch from a simple free tie. The exact trajectory varies by pedicle and operative approach.

Why It Works​

The described stitch combines three elements:

  1. Transfixion. The suture passes through the pedicle tissue near the clamp tip and through its midpoint.
  2. Clamp-assisted control. The pedicle is held during division and placement of the suture.
  3. Fixation where intended. In a uterosacral pedicle, the retained suture can assist later identification and cuff suspension.

Choice of ligature and whether an additional tie is needed depend on the specific pedicle and exposure.

Key Uses​

  • Vaginal hysterectomy. The stitch has been described for the uterosacral or other selected nonvascular pedicle. Vascular pedicles may require a different ligature strategy.[1][2]
  • Open abdominal hysterectomy. Transfixing sutures may secure selected clamped pedicles. In Wheeless and Roenneburg's abdominal sequence, uterine-vessel and cardinal pedicles are ligated without a pass through their vascular midportion because of hematoma or vessel-tearing risk.[3] Laparoscopic clips and energy devices are different methods.
  • Associated cuff support. A retained uterosacral suture can contribute to cuff fixation in the described vaginal hysterectomy sequence; formal prolapse suspension is a separate procedure.[2] For vaginal hysterectomy for benign conditions, the 2025 ISGE guideline describes cardinal–uterosacral cuff attachment as effective for preventing vault prolapse when there is no uterine prolapse or only stage I (Grade 2B), recommends McCall culdoplasty for stage II (Grade 1B), and advises considering sacrospinous fixation or sacrocolpopexy for stages III–IV (Grade 1B).[5]

Hemostasis and Ureteral Safety​

In the cited vaginal-hysterectomy sequence, inspect the broad-ligament pedicles for bleeding. If a wide bleeding area requires a running suture that plicates the pedicles to the lateral vaginal mucosa, do not place it deeper than the original pedicle ties to avoid ureteral injury.[2]

See also: Heaney Needle Driver, Heaney Retractor.

References​

1. Toronto Video Atlas of Surgery. Vaginal hysterectomy: case description and Heaney stitch for a selected nonvascular pedicle. University of Toronto; 2020.

2. Atlas of Pelvic Surgery. Total Vaginal Hysterectomy. Uterosacral, cardinal, uterine-vessel and adnexal pedicle technique descriptions.

3. Wheeless CR Jr, Roenneburg ML. "Total Abdominal Hysterectomy With and Without Bilateral Salpingo-oophorectomy." Atlas of Pelvic Surgery. n.d. Online chapter. Accessed 2026-10-04.

4. Cruikshank SH. "Vaginal hysterectomy." Glob Libr Womens Med. 2008. doi:10.3843/GLOWM.10041

5. Chrysostomou A, Noé G, Linnamägi A, van Herendael BJ, Djokovic D. "Evidence-based recommendations of the International Society for Gynecologic Endoscopy (ISGE) for the prevention of apical prolapse following vaginal hysterectomy for prolapsed and non-prolapsed uterus." Eur J Obstet Gynecol Reprod Biol. 2025;312:114559. doi:10.1016/j.ejogrb.2025.114559