Since the advent of laparoscopy, many inventions & innovations were made to carry out the procedures with ease. Advancements were suggested in the laparoscopic techniques, procedures & the instruments. To contribute in the field, we have used epidural needle as a fascial closure device or suture passer.

Many fascial closure devices are available in market e.g. Berci Fascial Closure Device (FCD), Gore suture passer etc.
• Berci FCD is used most commonly as fascial closure device or suture passer. It has got a stable arm and a movable arm, which are joined by hinge joint. The mobile arm can break if it is not closed properly while inserting the device. Literature shows the reports where fluoroscopy or even laparotomy was done to retrieve the broken arm.

• Gore suture passer works in a different manner but similar principle. Its mobile arm opens from the proximal side in which suture can be held and brought out. Mobile arm can break if remains open while withdrawing the instrument.

• To solve the problem, we have been using Epidural Needle for a couple of years for this purpose. A suture (our choice is no. 1 prolene) can be passed through its lumen and the end tied keeping the tied suture lengthier than the needle as shown in figure.

Uses
– Laparoscopic ventral hernia repair– used for exteriorizing sutures in four corner mesh fixation method.
– Facilitates port site closure.
– Controlling the abdominal wall bleeders.

The advantages of an epidural needle are:
– Easily available.
– Cost effective.
– Epidural needle cannot bend or break as Berci or Gore needle.
– Chances of injuring the intraperitoneal organs are less as its sharp distal end is curved sideways.
– Suture withdrawal is easier as the curved distal end provides a good circular loop of intraluminal prolene from which instruments can be passed easily to grasp the suture.

References
Katara AN, Bhandarkar DS, Shah RS, Udwadia TE. Breakage of fascial closure device during laparoscopic surgery. J Min Access Surg 2005;79-81.
Salemeh JR. Suture passer tip breakage during laparoscopic ventral hernia repair.
Surg laparosc Endosc Percutan Tech. 2005 Apr;15(2);112-4.