Needle lost in minimally invasive surgery: management proposal and literature review

Abstract

The reported incidence of intraoperative retained instruments, such as needles, hangs around 0.06-0.11%. Leaving a needle inside the abdominal cavity can have significant medical and legal consequences. In addition, the retrieval can be hampered due to the limited visualization of the scope during minimally invasive surgery. Factors associated with an increased probability for NL have been described. Prevention for this situation includes: having one needle at a time inside the cavity, effective communication between all personnel in the operating room, evaluation of the strength of the suture-needle connection, avoid parking of needles intraoperatively, and a proper needle withdrawal. Notwithstanding, no agreement has been made regarding NL management. Herein, we present a literature review, and a management proposal in which through a series of systematic steps, the surgical team can efficiently locate and retrieve a lost needle such as: examination of the surgical field, trocar visualization, trocar disassembly, and revision of the suction device. Finally, intraoperative or postoperative imaging can be utilized.

Three Different Learning Curves Have an Independent Impact on Perioperative Outcomes After Robotic Partial Nephrectomy: A Comparative Analysis

“…In contrast, the idea of minimizing the impact of bedside assistants has been discussed repeatedly in recent years. 17 Especially due to the addition of a fourth robotic arm, the fundamental need of an assistant has been questioned. 18 This concept has been corroborated by multiple studies that did not show an influence of assistants on perioperative outcomes.…”

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

“…Unexpected changes in surgical items and surgical team members make accurate counting and documentation more challenging and increase chances for communication failure between team members [2,3,9,17,20,22,24,26,[30][31][32]. The JC has identified failure of communication, absence/non-compliance with RSI policies and intimidation resulting from hierarchal concerns amongst the surgical team as the main contributing factors for RSI events [12,24,29,33,34].…”

“…Manual counting has been the mainstay for prevention of hard RSIs, however, even with development of new counting techniques and protocols, counting discrepancies remain a common event [12,39,40,55]. Studies report counting discrepancies occurring as often as 1 in every 8 cases, with sharps (typically needles) being the most miscounted item [7,12,30], followed by instruments and instrument fragments [17,18,55]. Incorrect manual counts are responsible for RSIs in approximately 62 to 88% of RSI events, and in approximately 20-50% of RSI events the surgeon proceeded with closing the patient even though at least one person was aware of a count discrepancy [3,7,56].…”

Intraoperative loss of surgical needle with 8–0 nylon: radiographic findings

“…Medina et al stated that it i s important to implement preventive measures against losing needles and that appropriate and clear communication between team members is important 2…”