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Endostitch™

The Endostitch™ (Medtronic / formerly Auto Suture / Covidien) is a laparoscopic automated suturing device originally developed for endoscopic suturing in general and gynecologic surgery. The defining mechanism is a toggling needle passed back and forth between two jaws via a thumb-actuated lever — a substantially faster and more reproducible alternative to free-needle laparoscopic suturing. Repurposed in urogynecology for vaginal vault fixation (SSLF) through its ability to quickly place multiple sutures in deep constrained spaces.

Design​

  • Pistol-grip handpiece with toggling lever actuator
  • Two opposing jaws at the distal end
  • Short suture loaded with a needle in between; each lever toggle passes the needle from one jaw to the other through tissue
  • 10 mm shaft — standard laparoscopic port compatible
  • Various suture materials pre-loaded (Polysorb, Biosyn, Surgipro)

Use in SSLF​

Although designed for laparoscopy, the Endostitch has been validated for vaginal sacrospinous colpopexy through the transvaginal approach:[1]

  • The device reaches the sacrospinous ligament through the posterior vaginal dissection
  • Rapid toggle mechanism places sutures without the need for visualization-minimal palpation required by classic suture-passers
  • Commonly used for bilateral SSLF and modified Mayo-McCall procedures

Use in Other Applications​

  • Laparoscopic sacrocolpopexy — mesh-to-sacrum and mesh-to-vaginal-cuff sutures
  • Laparoscopic Burch colposuspension — historic application
  • Laparoscopic hysterectomy — vaginal cuff closure
  • General surgery — hiatal hernia repair, bariatric reinforcement
  • Colorectal surgery — mesocolon and anastomotic reinforcement

Positioning in the SSLF Landscape​

The Endostitch sits alongside the Capio and i-Stitch as a contemporary automated suture-passing device. Its strength is versatility across laparoscopic and transvaginal applications — a single device a surgeon may already know from laparoscopic work, repurposed for SSLF.

References​

1. Lantzsch T, et al. Vaginal Sacrospinous Ligament Fixation With the Autosuture Endostitch Device. (Early validation of the transvaginal application.)

See also: Capio Suture Capturing Device, i-Stitch, RD180 Suturing Device (a related contemporary endoscopic suturing device).