A needle holder is one of the paramount instruments in surgery. Its primary function is to hold the needle steadily and securely while applying a surgical intervention. It helps surgeons provide a clear surgical field, thus avoiding injury to adjacent tissues and the surgeon’s hand. It is believed that needle holders originated in artery forceps and became popular only in the 19th century, as earlier surgeons used their hands to push needles while suturing. Needle holders are generally named after the scientist who designed them, for example, the Crile-Wood needle holder, Olsen-Hegar needle holder, Mathieu needle holder, Gillies needle holder, Mayo-Hegar needle holder, and many more.
The Mayo-Hegar needle holder is a versatile tool for applying heavy needle sutures. It is named after Dr. Charles Horace and Dr. Fritz Hegar, who contributed to its invention and improved needle control and suturing precision. This blog will focus on this holder, but the information shared here also applies to other needle holders.
Design of Mayo-Hegar Needle Holder
A Mayo-Hegar needle holder consists of the following parts:
Jaws: Jaws are positioned distal to the fulcrum. They can be of several types depending on the use:
- Broad: For heavy sutures.
- Narrow: For fine sutures.
- Straight/Smooth: For surface-level procedures.
- Curved: For deep penetration.
- Notched/Serrated: For a powerful grip.
- Gold-colored: For enhanced precision.
Handles: Shafts or handles are located distal to the fulcrum. They are available in two forms: straight or curved. The handles are finished with ringlets, allowing the surgeons to maintain a secure grip. Some unique kinds of gold-colored tungsten carbide handles are also available.
Ratchet mechanism: The ratchet mechanism allows the surgical needle holder to hold it securely when locked. The instrument usually features three interlocking teeth. These teeth offer the option to increase the spring force on the needle as the ratchets come together. With each additional tooth engagement, the needle grip’s strength is increased, making it more prone to bending. The orientation of the ratchet is designed for right-handed surgeons and may prove difficult to open for left-handed surgeons.
Gold-colored Jaws: The gold-colored jaws are of utmost importance, as they are made of Tungsten Carbide. Tungsten carbide is a hard material that offers better precision and control, and the opportunity to be replaced in case of wear. Its hard texture allows for a more significant number and increased prominence of teeth. The number of teeth may vary from 2500 to 16,000 per square inch. A drawback is that the hard tooth may bend or break the suture material if gripped directly with the needle holder instrument.
Methods for Mayo-Hegar Needle Holder Control
Palming:
Palming is a standard method in which the fingers do not enter the holes of the handles, allowing surgeons to rotate the instrument if required. However, this technique is considerably more complicated for left-handed surgeons and can be less precise for suturing with tiny needles.
Distal Finger Placement
For ease in opening the ratchet and handling the jaws, surgeons usually place the distal portions of the thumb and ring finger in the holes. This type of movement proved to be more precise than the palming technique. However, there is one disadvantage: it may decrease the degree to which the surgical needle holder can be rotated.
Thumb-Assisted Hybrid Grip
Some surgeons use a hybrid technique to palm the needle holder during the throw, then momentarily place their fingertips into the holes to help open the jaws and reload the needle. Once the reload is completed, the surgeon returns to palming for the next throw. Alternatively, this technique can be performed using just the thumb, resulting in minimal loss of speed, which the surgeons usually prefer.
Personalized Grip Preferences
Surgeons have long debated the most effective grip technique for the needle holder instrument or whether there is a single best grip. It is common practice for surgeons to change the grip techniques during a procedure, eliminating the need to adhere to one grip.
Conclusion
In conclusion, the Mayo-Hegar needle holder is a fundamental tool in modern surgical practice, providing improved precision and control. Its ergonomic design significantly improves needle control during suturing, even with tiny needles. Despite the wide range of grip techniques available to surgeons, it is clear that the Mayo-Hegar needle holder adapts to various methods based on personal preferences.
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