An abdominal incision suturing apparatus includes a guide element that is inserted and maintained in an abdominal incision by a guide handle. The guide element has a passage for receiving slidably the shaft of a reverse needle. The shaft can be moved axially and rotationally with respect to the guide element by a shaft handle. The reverse needle has a needle at the distal end of the shaft, with a pointed end and an eye for receiving a suture. The guide element defines a sheath for receiving the pointed end of the needle. The guide element and the reverse needle together present a substantially airtight surface for maintaining the pneumoperitoneum pressure in a cannula site incision. Further, the guide element includes markings on its surface, for the user to monitor the depth of insertion via a laparoscope. The shaft handle has a specially shaped groove, and the guide element has an internal pin that protrudes into the groove. The pin thus confines the reverse needle to axial and rotational movement between four consecutive positions with respect to the guide element. The four positions correspond to the pointed end being (1) sheathed, (2) unsheathed and in line with the guide element, (3) laterally spaced from, and (4) laterally adjacent to the guide element for puncturing. A locking mechanism further immobilizes the reverse needle in selected positions. An unlocking mechanism releases the needle for movement.