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For surgeons experienced in traditional open suturing, the challenge of obtaining correct needle positioning in the needle driver often becomes a surprise. In fact, it has been shown that for novice laparoscopic surgeons, needle grasping and positioning within the needle driver are the most difficult and time‐consuming laparoscopic tasks [6].

In our experience, determining if an acceptable perpendicular position has been obtained is one of the major challenges. Novices often do not understand the magnitude of the needle displacement until suturing is attempted and found to be near impossible. Self‐righting needle drivers or 3D systems may be important aids, but we have found that most trainees will learn the cues for needle positioning reasonably fast. If using a standard 3/8 circle needle, one cue to correct perpendicular needle positioning is that the light source is reflected along the side of the needle (ssss1).

When a perpendicular or near‐perpendicular needle position has been achieved, the suture bite is performed very similar to open surgery. Clockwise rotation of the instrument handle will allow tissue purchase within the arc of the needle.