A novel needle holder for suturing in a deep and narrow surgical field: a technical note.

Microvascular anastomosis is a standard procedure in neurosurgery that is applied to various lesions, such as those of ischemic disease and moyamoya disease. The depth of an anastomosis can be superficial or deep. At deeper sites, the procedure becomes challenging, as the operative field is usually narrow. Among the anastomotic approaches, suturing is the most challenging in a limited and deeper field. Additionally, since the suturing device is inevitably long, the delicate procedure becomes challenging. To overcome this technical difficulty and suture more efficiently, even in a narrow and deep field, the authors developed a needle holder, the REVOLD-HS, that allows rotational motion without moving the holder. This new needle holder is uniaxial and allows the forceps at the tip to be manipulated by operating the rotor in the hand. There is a mechanism for opening, closing, and rotating the holder via the surgeon's finger without moving the holder. Based on suture experiments in simulated blood vessels while using the holder, some situations may necessitate the use of this needle holder. This novel smart device may assist in deep vascular anastomosis in microsurgery, suturing of the carotid artery in carotid endarterectomy, and dural repair in endoscopic surgery.