Endostitch™
The Endo Stitch™ (Autosuture / Covidien / Medtronic) is a single-use endoscopic suturing device adapted for transvaginal sacrospinous ligament fixation (SSLF) in a small 1997 series. Its toggle-jaw mechanism transfers a needle between jaws. Endoscopic and vaginal use require different exposure and ergonomics; the cited laparoscopic timing and animal closure studies did not assess SSLF outcomes.[1][2][5][7]
Design
- Pistol-grip handpiece with toggle lever actuator
- Two opposing jaws at the distal end; needle automatically loaded for the next pass after each toggle
- Compatible loading units. Medtronic catalogs single- and triple-stitch units for the 10 mm device, with 9 mm sutured needles and material-, size- and length-specific options including 18 cm and 120 cm strands; confirm the selected loading unit's compatibility.[8]
- Endoscopic shaft. The current catalog lists a 34 cm (15 in) shaft; confirm the specific model and loading unit before use.[7]
- Single-use disposable
Mechanism Advantage — Per-Stitch Time
In Adams 1995, 41 Endo Stitch laparoscopic suturing maneuvers averaged 43 ± 27 seconds versus 14 conventional laparoscopic needle-holder maneuvers averaging 151 ± 24 seconds in urologic endoscopic procedures.[2]
Reconstructive / Urogyn Use — Vaginal SSLF
The Schlesinger 1997 transvaginal-SSLF series enrolled 17 patients, all undergoing concomitant procedures.[1]
| Endpoint | Result |
|---|---|
| SSL plication time | 18.8 ± 3.0 min (range 14–25) |
| Total-procedure EBL ≤ 100 mL | 15/17 (88.2%) |
| Perioperative complications | None |
| Vault support maintained at mean 9.8 mo follow-up | 15/17 (88.2%) in this small series |
| Recurrence | 11.8% (2 patients at 4 and 6 mo) |
Schlesinger suggested a shorter instrument would improve vaginal ergonomics for the model used then.[1]
Vascular Safety — Manning 2014 Cadaveric Comparison
The Manning 2014 cadaveric study found the Endo Stitch passage remained within the ligament in the specimens examined, unlike i-Stitch penetration of coccygeal branches.[4]
However, the Endostitch was slightly less ideal than the Capio and Caspari on Manning's framework: the ideal device should have the sharp penetrating component traverse the shortest distance at the shallowest depth. The Caspari and Capio best satisfied that criterion; the Endostitch did so "less so."[4]
Broader Surgical Applications
Endoscopic suturing applications described in the cited literature or manufacturer catalog include:[2][5][7]
- Laparoscopic pyeloplasty. Anderson-Hynes ureteropelvic reconstruction
- Laparoscopic bladder-neck suspension (historic Burch / paravaginal)
- GI viscerotomy closure. Omotosho 2011 tested barbed versus nonbarbed closures in dogs, with shorter closure time[5]
- General laparoscopic tissue approximation across specialties
Göpel 2011 evaluated an experimental motorized modification in a surgeon task simulation; faster completion (p = 0.01).[3]
Limitations
- Length. Designed for laparoscopic port access and somewhat cumbersome for vaginal SSLF (Schlesinger 1997 original-series caveat)[1]
- Ergonomics. Göpel described the conventional EndoStitch's ergonomics as limiting its use; the specific weight, size and cable complaints in that study concerned the experimental motorized prototype.[3]
- Single-use disposable. Recurring per-case cost[6]
- Needle-hole concern reported by Nagai 1999 for the historical model[6]
- Less ergonomic profile than purpose-built vaginal SSLF devices (Capio, i-Stitch) in surgeons who do transvaginal apical-suspension cases primarily
Endostitch vs Adjacent SSLF Devices
| Feature | Endostitch | Capio | Caspari | i-Stitch |
|---|---|---|---|---|
| Type | Suture-capturing (toggle-jaw) | Suture-capturing (throw-catch-retrieve) | Suture-capturing | Suture-capturing (blunt ball-tip) |
| Original design purpose | Laparoscopic surgery | Vaginal SSLF | Vaginal SSLF | Vaginal SSLF |
| Cadaveric trajectory (Manning 2014) | Remained within ligament | Remained within ligament | Remained within ligament | Penetrated coccygeal branches in tested thin ligaments |
| Penetration observation | Less ideal than Capio/Caspari by authors' geometric criterion | Shorter/shallower path in this model | Shorter/shallower path in this model | Deeper path in this model |
| Vaginal ergonomics | Length concern for Schlesinger's 1997 model | Purpose-built | Purpose-built | Purpose-built |
| Clinical inference | Small 17-patient combined-operation series | — | — | — |
Bottom Line
Endo Stitch is an endoscopic suturing option with limited published SSLF-specific clinical evidence. Use the current model-specific instructions and distinguish endoscopic, animal and vaginal evidence.[1][4][7]
See also: Capio Suture Capturing Device, i-Stitch, Anchorsure System, Saffron Fixation System, RD180 Suturing Device, Deschamps Ligature Carrier.
References
1. Schlesinger RE. "Vaginal sacrospinous ligament fixation with the Autosuture Endostitch device." Am J Obstet Gynecol. 1997;176(6):1358–62. doi:10.1016/s0002-9378(97)70358-2
2. Adams JB, Schulam PG, Moore RG, Partin AW, Kavoussi LR. "New laparoscopic suturing device: initial clinical experience." Urology. 1995;46(2):242–5. doi:10.1016/s0090-4295(99)80200-3
3. Göpel T, Härtl F, Schneider A, Buss M, Feussner H. "Automation of a suturing device for minimally invasive surgery." Surg Endosc. 2011;25(7):2100–4. doi:10.1007/s00464-010-1532-x
4. 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
5. Omotosho P, Yurcisin B, Ceppa E, et al. "In vivo assessment of an absorbable and nonabsorbable knotless barbed suture for laparoscopic single-layer enterotomy closure: a clinical and biomechanical comparison against nonbarbed suture." J Laparoendosc Adv Surg Tech A. 2011;21(10):893–7. doi:10.1089/lap.2011.0281
6. Nagai H, Araki S. "Semiautomatic suturing device (Maniceps) for laparoscopic surgery." Surg Endosc. 1999;13(2):191–3. doi:10.1007/s004649900937
7. Medtronic. Endo Stitch suturing device product catalog.
8. Medtronic. Operating Room Essentials: The Complete Solution. Product catalog, pp. 16–18. Accessed October 4, 2026.