Many surgical procedures involve the use of very small surgical needles. In the event that a postoperative needle count is incorrect, traditionally an x-ray has been taken to find the needle. Little data exist to recommend the smallest surgical needle that can be identified with conventional radiographic techniques and the optimum technique for finding lost surgical needles. In this quality assurance project x-rays of various size surgical needles were taken. The smallest seen by the majority of observers was 17 mm. The radiographic technique of choice for optimum detection of lost surgical needles was imaging with a mobile image intensifier.

Transanal endoscopic microsurgery is an effective, safe and cost-beneficial procedure for local excision of selected lesions in the middle and upper thirds of the rectum.

Although complications of laparoscopic totally extraperitoneal inguinal hernia repairs are well documented, the development of pneumothorax, pneumomediastinum and subcutaneous emphysema is rarely reported. The authors' experience with a 23-year-old man who developed intraoperative bilateral pneumothoraces and cervical subcutaneous emphysema during a laparoscopic totally extraperitoneal inguinal hernia repair prompted a MEDLINE literature review. Seven similar cases were found in which the patients developed pneumothorax, pneumomediastinum and/or subcutaneous emphysema following laparoscopic hernioplasty. An intercostal catheter was inserted in two out of the seven patients only. Numerous hypotheses were proposed for the development of these complications. Several authors felt that the duration of the procedure and preperitoneal insufflation pressures are related to the development of these complications. These potentially lethal complications must be diagnosed and managed promptly.

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