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i-Stitch®

The i-Stitch® (A.M.I. — Agency for Medical Innovations, Austria) is a reusable single-handed suture-fixation device designed specifically for attaching sutures to deep pelvic ligaments, particularly the medial posterior aspect of the sacrospinous ligament — a notoriously difficult-to-access target. Unlike the Capio family, the i-Stitch uses a blunt, ball-tipped suture that penetrates tissue without a sharp needle.

Design​

  • Reusable metal instrument with a loading unit
  • Needle slider with integrated suture clamp
  • Specially formed blunt, ball-shaped suture tip — the distinguishing feature; no sharp needle required
  • Curved working end for sacrospinous ligament approach
  • Paired with BSC Mesh (A.M.I. bilateral sacrospinous colpopexy mesh) in the manufacturer's apical suspension protocol

Technique​

  1. Secure the suture in the suture clamp of the i-Stitch loading unit
  2. Load the i-Stitch with the loading unit
  3. Guide the tip along the surgeon's finger to the intended sacrospinous ligament attachment point
  4. Push the ball tip into tissue
  5. Push the loading unit forward — the suture penetrates the ligament via the ball tip, without a sharp needle cut
  6. Retrieve the suture on the opposite side of the ligament

Advantages​

  • No sharp needle — reduced risk of unintended injury during blind ligament engagement
  • Minimal transvaginal dissection — the device is navigated by palpation along the surgeon's finger
  • No excessive preparation or visualization of the sacrospinous ligament required
  • Safe, precise, reproducible suture placement per manufacturer design

Use in Urogynecology​

  • Bilateral sacrospinous ligament fixation (SSLF) — typically paired with the BSC Mesh
  • Apical vaginal vault suspension
  • Uterovaginal prolapse repair
  • Post-hysterectomy vault prolapse

Positioning​

The i-Stitch sits alongside the Capio and Endostitch as a contemporary suture-based SSLF device (distinct from the anchor-based Anchorsure and Saffron). Its distinguishing signature is the blunt ball tip and finger-guided approach — features valued by surgeons who prefer a tactile, visualization-minimal technique.

See also: Capio Suture Capturing Device, Endostitch, Anchorsure System.