Intraoperative Loss of a Surgical Needle: A Laparoscopic Dilemma

Abstract

Background:Increasing awareness around patient safety and efforts to reduce medical errors has become a priority in the modern health care system. Losing needles during laparoscopic procedures is an uncommon occurrence; however, it poses a significant dilemma for the operating surgeon because retrieval can be a major challenge even for highly skilled and experienced operators.Objective:The objective of this paper was to review the current literature and highlight this potentially serious issue and suggest a method of dealing with this uncommon occurrence.Methods:A comprehensive literature search was conducted using several Internet search engines including PubMed, Google Scholar, and ScienceDirect.Conclusions:The risks associated with retained small foreign bodies remains unknown, and there are few reports and little consensus on how surgeons should manage retained needles or other small foreign bodies during laparoscopic surgery. We propose an algorithm that may be implemented as a standard operating procedure in surgical theatres when a surgeon is faced with such a dilemma.

Risk factors and preventive strategies for unintentionally retained surgical sharps: a systematic review

“…With the increasing use of minimally invasive surgical (MIS) techniques, there has been an expected increase in RSIs associated with MIS as compared to open procedures [ 12 ]. Risk factors associated with MIS include a limited field of view and the lack of tactile feedback for the operator [ 12 , 17 , 22 ] which make it more difficult to locate a lost object and therefore increase the risk of an RSI event [ 35 , 36 ].…”

“…Local reactions to RSIs can be inflammatory and exudative resulting in abscesses, fistulas, obstructions, or erosions into nearby structures [24,30,46,[61][62][63]. Reactions can also be aseptic, forming stable granulomas, the progression of which can bring to compression on nearby structures, causing chronic pain and irritation or other more significant symptoms [10,21,22,30,35,44,61]. Complications of RSIs have been described in a variety of case reports, and it has been shown that patients with known RSIs are twice as likely to have at least one post-operative complication, with morbidity of approximately 50% [2,30] and an extension of hospital stay in 59% up to 8 days [38].…”

“…Given the shift in the predominant type of RSIs from soft objects to hard [13,15], new technologies that address hard retained foreign bodies must be explored to further reduce the total incidence of RSI events. Various identification and retrieval devices seem to be promising with increasing the success of metallic RSI retrieval [35,59].…”

A Case Report of a Buried Needle in an Oculofacial Trauma

“…After initial survey does not reveal the needle, they recommend the use of an intraoperative magnetic needle retriever which is a reliable and rapid method for recovery. 21…”

Retained Needle in the AirSeal Trocar During Robot-Assisted Laparoscopic Radical Prostatectomy: Lessons Learned

“…Zaman and coworkers have recently noted that minimally invasive surgery using robotic systems, often with multiple bedside members and a large array of instruments, increases the chance of losing foreign bodies. 3 A missing foreign body is an unnerving event which prompts an active and exhaustive search, ideally performed in a systematic manner to increase the chances of identification and retrieval. Jayadevan and associates recently suggested a lost needle identification protocol that includes initial operative field survey, radiograph for needle >13 mm, port inspection, anatomically systematic visual search, and floor/table sweep.…”