Lost Specimen in the Abdominal Wall: A Novel Approach to Retrieval

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<h3>Study Objective</h3> To demonstrate a novel use of the operative hysteroscope to locate a specimen lost in the abdominal wall <h3>Design</h3> Surgical video. <h3>Setting</h3> Operating room. <h3>Patients or Participants</h3> 57-year-old G2P2002 post-menopausal patient with chronic left sided pelvic pain. <h3>Interventions</h3> The patient's pre-operative imaging revealed dilated left pelvic varices. She was counseled and consented for diagnostic laparoscopy with left oophorectomy and opportunistic bilateral salpingectomy. During attempted retrieval of the transected left ovary, the specimen became lodged in the abdominal wall within the left lateral incision and was lost to visualization. We inserted an operative hysteroscope through the left lateral incision to locate the specimen within the abdominal wall. Hysteroscopic graspers were used to grasp and push the specimen back into the peritoneal cavity, where the specimen was divided into small pieces for complete removal. <h3>Measurements and Main Results</h3> A specimen lost in the abdominal wall was located with an operative hysteroscope, retrieved, and successfully removed from the peritoneal cavity. <h3>Conclusion</h3> One of the challenges of laparoscopy is removing larger pathology from small incisions. If faced with a specimen, needle or instrument tip that becomes lodged in the abdominal wall, an operative hysteroscope can provide distension for better visualization and an operative channel for instrumentation to locate the lost items.