Similar to a hemostat, a needle holder is a surgical tool used by physicians and surgeons to hold and push a suturing needle during wound closure, ligation, and other procedures requiring re-anastomosis. It is sometimes referred to as a needle driver or needle forceps.

As specialized forceps, the parts of a standard needle holder consist of the hinged joint, the handles (usually with finger rings at the end), and the jaws (which are frequently reinforced with tungsten carbide inserts). The majority of needle holders also feature a ratchet mechanism that securely clamps the needle between the jaws and locks the grips together, enabling the user to move the needle through a variety of tissues without continually tightening their grasp.

The jaws are generally rough and shorter than the handles in order to provide a solid grip on the needle (raising the mechanical advantage of utilizing the principle of a lever).

Like scissors, the majority of needle holders are meant to be held in the fingers and palms. Nevertheless, some are made to have a grip similar to tweezers, enabling finer, more accurate movements around fragile objects or small areas. One such instrument is the Castroviejo needle holder, which is frequently utilized in dental, microsurgical, and ocular procedures.

Note: The needle size that a needle holder is designed for should match.

When suturing tissues, suture needles are held in place by needle holders. Metal-on-metal contact between the jaws of the needle holder quickly wears down the gripping surfaces. Regular tests of the function of needle holders should involve inserting a needle of the proper size into the jaws and noting whether the needle rotates, indicating the need for repair. One of the distinguishing features of superior needle drivers is the use of tungsten carbide inserts.  When the needle grip is no longer suitable, the tungsten carbide inserts can be changed.

Skills Required to Use Needle Holders

• Using a wide-based tripod grip to hold needle holders; swiftly and smoothly opening and closing the locking mechanism; and controlling the insertion and extraction of the needle in the tissues.
• Usage of needle holders effectively when suturing (reducing the number of actions necessary to position, insert and extract needle, tie a square knot) safe, reproducible square knot formation employing needle drivers
• For certain designs, tungsten-carbide tips are available.
• Strong metal reinforcement with fine cross striations strengthens the tips to ensure a longer lifespan and a secure fit for a greater variety of needle sizes.

Types of Needle Holder

1.      Mayo-Hegar

During surgical procedures, this tool is used to grasp and manage curved needles. This heavy-duty needle driver lacks a cutting blade and has a slightly tapered tip

• Short, strong jaws
• Durable
• Securely grasps variations of needle sizes
• Comes in multiple sizes

2.      Olsen-Hegar

This needle holder can save time for surgeons operating alone because it also has scissor blades at the base of the jaws. The risk of inadvertently cutting the suture material while working is one of its drawbacks. 

• Combination of needle holder and suture scissor.
• Beneficial for surgeons operating alone
• Suture can be cut and placed without altering instruments
• Combination tip is less sturdy across a range of needle sizes
• Can unintentionally cut the suture

3.      Mayo Hegar and Olsen-Hegar

 Mayo Hegar (right) and Olsen-Hegar (left). Observe the variation in the length of the jaws on the Olsen-Hegar needle holders (Left) and their inclusion of cutting blades for cutting sutures.

•  Possess ratchet locking mechanisms and handles with rings.
• Because a range of needle sizes are used often and the needles tend to slip or rotate when introduced into tissues.
•  Jaws are wider and shorter than hemostats.

4.      Castroviejo (Microvascular)

These needle holders fit into the pencil grip and are compact. They are usually used for microvascular surgery and have a spring and latch system that enables gentle locking and unlocking.

5.      Mathieu Needle Holder

With a ratchet lock located at the proximal end of the handles, Mathieu needle holders allow the surgeon to lock and unlock the tool by applying pressure with a palmed grip.

• Standard grip.
• Tips of the ring and thumb finger are placed in rings.
• Index finger is placed along the handle towards the fulcrum to stabilize the tips.
• Wrist rotation is beneficial for driving the needle through tissues.
• Grip provides excellent accuracy.
• Slight movement of needle and instrument when jaws opened.
• Recommended for beginner surgeons

Testing Before Use

The back of your hand should be able to accommodate a hair in a needle holder. If not, something is wrong with it. The jaw surfaces' ability to maintain a firm grip is compromised by wear and tear. The jaws and other components of the needle holder may potentially get bends and fractures. Prior to sterilization, as well as after every surgery, needle holders should be inspected. Examine the item for any of the following defects using a magnifying glass or microscope and a bright lamp. When the needle holder is closed, no light should show through the jaw surfaces when held up to a strong light.

Either the jaw or the jaw insert is worn out if light only passes through a tiny area of the jaws. A worn-out jaw insert needs to be replaced by an authorized vendor or by the manufacturer. It is necessary to replace the needle holder in its entirety if the jaw is worn. One of the jaws is most likely twisted if a sizable amount of the surface is visible to the light.

fractures in the joint or jaws

The standard of the instrument is exposed to even tiny fractures and should not be used in emergency cases.

cracks in jaw

The tips are where most insert damage happens. If any cracks are noticed, the insert needs to be changed. An insert tip has to be replaced if it appears and feels noticeably less coarse than the rest of the insert.

Stain or Rust

To ascertain whether a discoloration that is brown or orange is caused by rust or a stain, vigorously rub a pencil eraser over a portion of the discoloration. It is rust and needs to be properly brushed with a brass brush or soaked in a rust removal solution if the discoloration and pit marks cannot be eliminated. It is a stain that can be removed by soaking in a stain removal solution if it can be removed and the smooth metal underlying can be found.

loose joint

 Take one ring handle in each hand, open the instrument, and gently press one handle up and down. The instrument should have some give and take, but if it seems excessively loose, it has to be fixed.

Loose ratchet fit

Verify that the jaw closes fully in the third ratchet position and that the tips close in the first. When the instrument is locked in the second ratchet position and a needle held in the jaws of a needle holder is easily moved by hand, the repair is required.

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