Deschamps Ligature Carrier
The Deschamps ligature carrier is the oldest and most widely used suture-passing instrument for sacrospinous ligament fixation (SSLF) in transvaginal pelvic-organ-prolapse repair. Named for the 18th-century French surgeon Joseph-François-Louis Deschamps, it is a reusable, curved, blunt-tipped needle-like instrument that carries suture through the coccygeus / sacrospinous ligament complex by palpation alone — no direct visualization. It has the largest cumulative clinical experience base of any SSLF device (thousands of cases across multiple large series), counterbalanced by slow suture placement, intermediate vascular safety, and the highest blood-transfusion rate in pooled meta-analytic data.[1][2][3]
Design
- Right- and left-curved variants — allow either-side approach depending on working angle
- Curved blunt-tipped needle with eye near the tip for suture engagement
- Long handle for deep pelvic / paravaginal approach
- Reusable metal construction — autoclavable across many cases
- Multiple sizes — smaller for vaginal / pelvic work, larger for general-surgery pedicle ligation
Technique
- Suture threaded through the tip eye.
- Surgeon palpates the sacrospinous ligament (~ 2 fingerbreadths medial to the ischial spine).
- Carrier advanced through the coccygeus / sacrospinous complex with the curve matching the surrounding anatomy.
- Suture disengaged from the eye on the far side, retrieved.
- Carrier withdrawn, leaving the suture through the ligament.
The procedure is palpation-guided without direct visualization — the central technical limitation that drives most of the device's modern disadvantages.[2][3]
Suture-Placement Time
Notably slower than automated devices: ~ 775–795 sec (~ 13 min) per suture with the Deschamps vs ~ 47–49 sec with automatic suturing instruments.[1][4]
Clinical Evidence — The Largest Volume of Any SSLF Device
| Series | Design | Key Result |
|---|---|---|
| Doğanay & Aksakal 2013 | Large prospective randomized, 1,464 pts over 10 yr — Deschamps n=762 vs automatic suturing instrument n=702 | Deschamps had significantly longer suturing time, greater postoperative analgesic requirement, and longer hospital stay (all p < 0.05)[4] |
| Pollak 2007 comparative | Retrospective 240 pts — Deschamps (173) vs direct-vision needle driver (46) vs Miya Hook (21) | No significant difference in intraoperative complications; Deschamps had significantly higher postoperative complications vs direct visualization (18% vs 2%, p=0.002)[2] |
| Chopra 2019 Henry Ford | 34 pts unilateral SSLF with Deschamps | Median preoperative POP-Q stage 3 improved to postoperative stage 0 (p < 0.05)[5] |
Complication Profile — Amiri 2024 Meta-Analysis Signal
The Amiri 2024 systematic review + meta-analysis of 125 studies / 10,216 cases placed the Deschamps and Modified Deschamps at the top of the blood-transfusion-rate hierarchy across SSLF devices:[6]
| Pooled metric | Result |
|---|---|
| Overall reoperation rate | 1.2% |
| Overall nerve-injury rate | 3.8% (highest with Capio) |
| Overall hematoma rate | 1.7% (highest with Laurus / Raz anchoring) |
| Blood-transfusion rate | Highest with Modified Deschamps and Deschamps |
The transfusion-rate signal is the most actionable contemporary safety caveat — consistent with both the intermediate-vessel-deflection profile (below) and the long suture-placement time, which prolongs vessel impingement.
Vascular Safety — Manning 2014 Intermediate Position
Manning 2014 six-device cadaveric comparison placed the Deschamps in the intermediate safety category for thin sacrospinous ligaments — alongside the Miya Hook:[3]
| Safety class | Devices |
|---|---|
| Safest (remained within ligament) | Capio, Caspari, Endostitch |
| Intermediate (impinged but deflected vessels behind thin ligaments) | Deschamps, Miya Hook |
| Unsafe (penetrated vessels) | i-Stitch |
Manning's conclusion: the Deschamps and Miya Hook "may be a good compromise for the developing world where cost is important" — the cost / safety trade-off that defines this instrument's contemporary niche.[3]
Related Device — Veronikis Ligature Carrier (VLC)
The Veronikis Ligature Carrier (VLC) was designed by Veronikis and Nichols (1997) as a purpose-built improvement over the Deschamps specifically for transvaginal sacrospinous colpopexy:[7]
- Permits bite acquisition under direct surgical visualization within the pararectal space
- Allows ample penetration through the coccygeus muscle without restriction of suture type, size, or number
- Original 71-pt series: no operative complications[7]
- Long-term outcomes (Wu 2020 series, n = 453): objective cure rate 82.5%; anterior compartment recurrence 12.6% (the most common pattern)[8]
- Chou 2010 clinical-outcomes confirmation in transvaginal SSLF with the VLC[9]
The VLC sits between the Deschamps (palpation-only) and the Capio (single-motion throw-catch-retrieve) — a reusable direct-vision improvement on the classic ligature-carrier concept.
Other Reconstructive / General-Surgery Uses
- Uterosacral ligament suspension via the Deschamps technique
- Deep pedicle ligation in complex pelvic dissection
- Pedicle encirclement during hysterectomy or complex pelvic reconstruction when a right-angle clamp is too bulky
Advantages and Limitations
| Dimension | Detail |
|---|---|
| Cost | Low — reusable, autoclavable; the predominant SSLF device in cost-constrained settings |
| Suture placement time | ~ 13 min vs ~ 47 sec for automatic devices — the dominant ergonomic disadvantage[1][4] |
| Postoperative complications | Significantly higher vs direct-vision needle driver (18% vs 2%, Pollak 2007)[2] |
| Blood-transfusion rate | Highest among SSLF devices in pooled meta-analysis (Amiri 2024)[6] |
| Vascular safety in thin ligaments | Intermediate — impinges but deflects (Manning 2014)[3] |
| Visualization | Palpation only — no direct vision |
| Clinical track record | Largest of any SSLF device (thousands of cases) |
| Resource setting | Workhorse in resource-limited / cost-constrained settings[3] |
Position in the SSLF Device Family
| Device | Type | Suture time | Vascular safety | Key complication | Cost |
|---|---|---|---|---|---|
| Deschamps | Ligature carrier | ~ 795 sec | Intermediate (deflects vessels) | Highest blood-transfusion rate[6] | Low (reusable) |
| Miya Hook | Ligature carrier | Not reported | Intermediate (deflects vessels) | Comparable to others | Low (reusable) |
| Veronikis (VLC) | Direct-vision ligature carrier | — | Direct-vision advantage | No operative complications in 71-pt original | Low (reusable) |
| Capio | Suture-capturing | Rapid | Safe (within ligament) | Highest nerve injury (3.8%) | High (disposable) |
| Caspari | Suture-capturing | Rapid | Safest | Low overall | High (disposable) |
| Endostitch | Suture-capturing | Rapid (~ 47 sec) | Safe (within ligament) | Ergonomic limit for vaginal use | High (disposable) |
| i-Stitch | Suture-capturing | Rapid | Unsafe (penetrates vessels) | Vascular injury in thin ligaments | Moderate |
| Anchorsure | Anchor-based | Rapid | Tacker dislodgement 2.2% | Operator injury (glove tear / finger cut) | High |
| Saffron | Anchor-based | Rapid | Cadaveric only | No clinical data | High |
Bottom Line
The Deschamps Ligature Carrier remains a widely used, low-cost, reusable instrument with the largest clinical experience base for SSLF. Its main disadvantages are slow suture placement (~ 13 min), palpation-guided technique without direct visualization, higher postoperative complication rates vs direct-vision techniques, and the highest blood-transfusion rate in pooled meta-analytic data. It remains particularly relevant in resource-limited settings where cost is the primary consideration. For surgeons preferring the reusable ligature-carrier concept but wanting direct visualization, the Veronikis ligature carrier (VLC) is the modern purpose-built upgrade.[1][2][3][6][7]
See also: Miya Hook, Capio Suture Capturing Device, Endostitch, i-Stitch, Anchorsure System, Saffron Fixation System.
References
1. Aksakal OS, Ozyer SS, Güngör T, et al. "Comparison of a new technique with Deschamps ligature carrier for sacrospinous ligament fixation." Arch Gynecol Obstet. 2007;276(6):591–4. doi:10.1007/s00404-007-0377-6
2. Pollak J, Takacs P, Medina C. "Complications of three sacrospinous ligament fixation techniques." Int J Gynaecol Obstet. 2007;99(1):18–22. doi:10.1016/j.ijgo.2007.04.028
3. 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
4. Doğanay M, Aksakal O. "Minimally invasive sacrospinous ligament suspension: perioperative morbidity and review of the literature." Arch Gynecol Obstet. 2013;287(6):1167–72. doi:10.1007/s00404-012-2687-6
5. Chopra J, et al. "Henry Ford Hospital series — unilateral SSLF with Deschamps ligature carrier." Basic Science Podium/Poster, ICS. Neurourol Urodyn. 2019;38 Suppl 1:S6–S255. doi:10.1002/nau.23949
6. Amiri E, Bastani P, Mallah F, Mostafaei H, Salehi-Pourmehr H. "Comparison of the complications rate of different suture-passing techniques at the time of sacrospinous ligament fixation: a systematic review and meta-analysis." Arch Gynecol Obstet. 2024;310(6):2791–2809. doi:10.1007/s00404-024-07788-5
7. Veronikis DK, Nichols DH. "Ligature carrier specifically designed for transvaginal sacrospinous colpopexy." Obstet Gynecol. 1997;89(3):478–81. doi:10.1016/S0029-7844(96)00522-4
8. Wu CJ, Chang WC, Huang KJ, et al. "Long-term follow-up of 453 patients with pelvic organ prolapse who underwent transvaginal sacrospinous colpopexy with Veronikis ligature carrier." Sci Rep. 2020;10(1):4997. doi:10.1038/s41598-020-61995-z
9. Chou LY, Chang DY, Sheu BC, et al. "Clinical outcome of transvaginal sacrospinous fixation with the Veronikis ligature carrier in genital prolapse." Eur J Obstet Gynecol Reprod Biol. 2010;152(1):108–10. doi:10.1016/j.ejogrb.2010.05.020