Deschamps Ligature Carrier
The Deschamps ligature carrier is a reusable, curved suture-passing instrument used for transvaginal sacrospinous ligament fixation (SSLF). Named for the French surgeon Joseph-François-Louis Deschamps, it can pass suture through the coccygeus–sacrospinous complex using palpation when direct visualization is limited. Comparative series report slower placement than the particular automatic instruments tested; a later meta-analysis flagged a transfusion signal for Deschamps and modified Deschamps.[1][2][6]
Design
- Right- and left-curved variants. Allow either-side approach depending on working angle
- Curved blunt-tipped needle with eye near the tip for suture engagement
- Long handle for deep pelvic / paravaginal approach
- Reusable metal construction. Follow the specific instrument's processing instructions
- Multiple sizes. Smaller for vaginal or pelvic work, larger for general-surgery pedicle ligation
Technique
- Suture threaded through the tip eye.
- Surgeon palpates the sacrospinous ligament and selects a shallow bite. Two fingerbreadths medial to the ischial spine is a described landmark, but does not guarantee vascular safety because vessel course and ligament thickness vary.[3]
- Carrier advanced through the coccygeus / sacrospinous complex with the curve matching the surrounding anatomy.
- Suture disengaged from the eye on the far side, retrieved.
- Carrier withdrawn, leaving the suture through the ligament.
This described passage is palpation-guided; exposure, the selected bite, and safe distance from the ischial spine remain important regardless of carrier.[2][3]
Suture-Placement Time
In the Aksakal 2007 and Doğanay 2013 comparisons, reported suturing times were approximately 775–795 seconds with Deschamps versus 46–49 seconds with the automatic instruments used in those studies.[1][4]
Clinical Evidence
| Series | Design | Key Result |
|---|---|---|
| Doğanay & Aksakal 2013 | Large prospective randomized, 1,464 pts over 10 yr — Deschamps n=762 vs automatic suturing instrument n=702 | Deschamps had significantly longer suturing time, greater postoperative analgesic requirement, and longer hospital stay (all p < 0.05)[4] |
| Pollak 2007 comparative | Retrospective 240 pts — Deschamps (173) vs direct-vision needle driver (46) vs Miya Hook (21) | No significant difference in intraoperative complications; Deschamps was associated with more postoperative complications judged related to suture passage than direct visualization (18% vs 2%, p=0.002)[2] |
| Chopra 2019 Henry Ford | 34 pts unilateral SSLF with Deschamps | Median preoperative POP-Q stage 3 improved to postoperative stage 0 (p < 0.05)[5] |
Complication Profile — Amiri 2024 Meta-Analysis Signal
The Amiri 2024 systematic review and meta-analysis included 125 studies with 10,216 cases. Transfusion rates were higher with Deschamps and modified Deschamps devices; the percentages below are pooled across all devices.[6]
| Pooled metric | Result |
|---|---|
| Overall reoperation rate | 1.2% |
| Overall nerve-injury rate | 3.8% across included studies; the abstract ranks Capio highest but gives no Capio-specific rate |
| Overall hematoma rate | 1.7% (highest with Laurus / Raz anchoring) |
| Blood-transfusion rate | Highest with Modified Deschamps and Deschamps |
Vascular Safety — Manning 2014 Intermediate Position
In Manning 2014's cadaveric comparison, Deschamps and Miya impinged but deflected vessels behind thin ligaments.[3]
| Safety class | Devices |
|---|---|
| Remained within ligament in this model | Capio, Caspari, Endostitch |
| Impinged but deflected vessels in this model | Deschamps, Miya Hook |
| Penetrated coccygeal branches in this model | i-Stitch |
Related Device — Veronikis Ligature Carrier (VLC)
The Veronikis Ligature Carrier (VLC) was described by Veronikis and Nichols (1997) for transvaginal sacrospinous colpopexy:[7]
- Permits bite acquisition under direct surgical visualization within the pararectal space
- Allows ample penetration through the coccygeus muscle without restriction of suture type, size, or number
- Original 71-pt series: no operative complications[7]
- Long-term procedure-cohort outcomes (Wu 2020, n = 453, often with concomitant repairs): objective cure 82.5%; anterior recurrence 12.6%.[8]
- Chou 2010 clinical-outcomes confirmation in transvaginal SSLF with the VLC[9]
Other Reconstructive / General-Surgery Uses
- Uterosacral ligament suspension via the Deschamps technique
- Deep pedicle ligation in complex pelvic dissection
- Pedicle encirclement during hysterectomy or complex pelvic reconstruction when a right-angle clamp is too bulky
Advantages and Limitations
| Dimension | Detail |
|---|---|
| Cost | Reusable carrier; actual cost depends on model and reprocessing |
| Suture placement time | Approximately 13 minutes versus under 1 minute for the tested automatic instruments in two studies[1][4] |
| Postoperative complications | Pollak's retrospective series reported postoperative complications judged related to suture passage in 18% with Deschamps versus 2% with direct vision[2] |
| Blood-transfusion signal | Ranked high for Deschamps/modified Deschamps in Amiri's abstract[6] |
| Cadaveric vessel trajectory | Impinged but deflected vessels in Manning's thin-ligament model[3] |
| Visualization | Palpation only — no direct vision |
| Clinical track record | Multiple clinical series; no verified all-device volume ranking |
| Resource setting | Reusability may help where supply costs constrain options[3] |
Position in the SSLF Device Family
| Device | Type | Relevant comparison | Evidence limit |
|---|---|---|---|
| Deschamps | Ligature carrier | Slower than tested automatic instruments | Transfusion rank from meta-analysis abstract; no verified absolute device rate[1][4][6] |
| Miya Hook | Ligature carrier | Vessel deflection in Manning cadavers[3] | — |
| Veronikis (VLC) | Direct-vision carrier | 71-patient initial series | No comparative device-superiority trial here[7] |
| Capio, Caspari, Endostitch | Suture-capturing | Stayed within ligament in Manning cadavers | The 3.8% pooled nerve-injury figure is not a Capio rate[3][6] |
| i-Stitch | Suture-capturing | Coccygeal-branch penetration in Manning cadavers[3] | — |
| Anchorsure, Saffron | Permanent anchors | Distinct fixation mechanism | — |
Bottom Line
Deschamps remains a reusable palpation-guided option. In specific comparative cohorts it took longer to place sutures than automatic instruments, while a retrospective series associated it with more postoperative complications than direct vision. The direct-vision VLC is another carrier option; choice should reflect exposure, anatomy, training, processing and available instruments.[1][2][3][6][7]
See also: Miya Hook, Capio Suture Capturing Device, Endostitch, i-Stitch, Anchorsure System, Saffron Fixation System.
References
1. Aksakal OS, Ozyer SS, Güngör T, et al. "Comparison of a new technique with Deschamps ligature carrier for sacrospinous ligament fixation." Arch Gynecol Obstet. 2007;276(6):591–4. doi:10.1007/s00404-007-0377-6
2. Pollak J, Takacs P, Medina C. "Complications of three sacrospinous ligament fixation techniques." Int J Gynaecol Obstet. 2007;99(1):18–22. doi:10.1016/j.ijgo.2007.04.028
3. Manning JA, Arnold P. "A review of six sacrospinous suture devices." Aust N Z J Obstet Gynaecol. 2014;54(6):558–63. doi:10.1111/ajo.12272
4. Doğanay M, Aksakal O. "Minimally invasive sacrospinous ligament suspension: perioperative morbidity and review of the literature." Arch Gynecol Obstet. 2013;287(6):1167–72. doi:10.1007/s00404-012-2687-6
5. Chopra J, et al. "Henry Ford Hospital series — unilateral SSLF with Deschamps ligature carrier." Basic Science Podium/Poster, ICS. Neurourol Urodyn. 2019;38 Suppl 1:S6–S255. doi:10.1002/nau.23949
6. Amiri E, Bastani P, Mallah F, Mostafaei H, Salehi-Pourmehr H. "Comparison of the complications rate of different suture-passing techniques at the time of sacrospinous ligament fixation: a systematic review and meta-analysis." Arch Gynecol Obstet. 2024;310(6):2791–2809. doi:10.1007/s00404-024-07788-5
7. Veronikis DK, Nichols DH. "Ligature carrier specifically designed for transvaginal sacrospinous colpopexy." Obstet Gynecol. 1997;89(3):478–81. doi:10.1016/S0029-7844(96)00522-4
8. Wu CJ, Chang WC, Huang KJ, et al. "Long-term follow-up of 453 patients with pelvic organ prolapse who underwent transvaginal sacrospinous colpopexy with Veronikis ligature carrier." Sci Rep. 2020;10(1):4997. doi:10.1038/s41598-020-61995-z
9. Chou LY, Chang DY, Sheu BC, et al. "Clinical outcome of transvaginal sacrospinous fixation with the Veronikis ligature carrier in genital prolapse." Eur J Obstet Gynecol Reprod Biol. 2010;152(1):108–10. doi:10.1016/j.ejogrb.2010.05.020