Surgical Mystery

Abstract

Close multidisciplinary collaboration allowed for proper diagnosis and the safe retrieval of the missing rongeur tip from the left ventricle.

Stepwise Retrieval of a Broken Pituitary Disc Rongeur

“…Attempts to remove iatrogenic foreign bodies exacerbate the risks associated with spinal procedures, including nerve root injury, vascular complications, durotomy, infection, and reoperation [1]. Furthermore, attempts to remove a foreign object may incidentally advance it through the anterior longitudinal ligament [3]. Retroperitoneal vascular insult can ensue from anterior displacement without much evidence of bleeding in the surgical field of view due to elasticity of the anterior longitudinal ligament [3].…”

“…Furthermore, attempts to remove a foreign object may incidentally advance it through the anterior longitudinal ligament [3]. Retroperitoneal vascular insult can ensue from anterior displacement without much evidence of bleeding in the surgical field of view due to elasticity of the anterior longitudinal ligament [3]. Anterior displacement of the rongeur tip can lead to bleeding, embolization, or other retroperitoneal insult [3].…”

“…Retroperitoneal vascular insult can ensue from anterior displacement without much evidence of bleeding in the surgical field of view due to elasticity of the anterior longitudinal ligament [3]. Anterior displacement of the rongeur tip can lead to bleeding, embolization, or other retroperitoneal insult [3]. Under certain conditions, the importance of removal may be diminished, but these decisions depend greatly on location and specifics for the case.…”

“…While this approach possibly relies on greater muscle and fascial dissection, studies have not shown greater risk of complications when compared to alternative approaches (microendoscopic discectomy, percutaneous discectomy) [1]. This approach can, however, be complicated by rare, but serious iatrogenic vascular injury owing to pituitary disc rongeur protrusion through the anterior longitudinal ligament, and subsequently the retroperitoneal space [3]. Incidents of this nature are typically avoided by surgical care and intraoperative imaging, but these can also depend on the integrity of surgical instruments [4].…”

Breakage of a Pituitary Rongeur Tip: An Unforeseen Complication of Lumbar Microdiscectomy

“…The reported incidence of surgical errors, which includes surgical instrument breakage, varies from 3.1% for open microdiscectomy to 1% for microendoscopic discectomy 5 . A methodologically safe and efficient way of removal of such retained pieces is required to avoid anterior displacement, which can lead to bleeding, embolization, or other retroperitoneal insults 6,7 . We present a case of broken pituitary rongeur tip during a lumbar microdiscectomy surgery, which was retrieved carefully with extreme caution.…”