Needle Loss in Minimal Invasive Surgery Is a Real Challenge: Innovative Technique for Retrieval

Abstract

Introduction: Intraoperative retained needles is reported to be ~0.06% to 0.11% with its consequence medical and ethical significance.1 Such small needles can be detached from the sutures and fly away from the limited laparoscopic vision or hidden between bowel loops that makes its localization and retrieval extremely difficult even in the hands of best experienced surgeons.2 However, intraoperative radiographic images maybe used in detecting lost needle; smallest needle <13 mm can be unhelpful.3 Kandioler-Eckersberger et al. reported two cases in which a novel laparoscopic magnetic retrieval device was utilized along with fluoroscopy in retrieval of broken fragments without the need to convert to open surgery.4 Herein, we demonstrate an innovative technique in retrieving a small suture needle that was lost during robotic pyeloplasty. Methods and Materials: This is a 7-year-old boy who was recently found to have left-sided pelviureteral junction obstruction after frequent emergency department visits with colicky abdominal pain. Ultrasonography and nuclear scans showed high-grade hydronephrosis with an obstructive curve; therefore, he was posted for robotic pyeloplasty. During the procedure and while doing the ureteropelvic anastomosis through 6/0 polydioxanone suture, the needle detached from the suture and was lost from the camera vision. At the end of the procedure, exploration of the abdominal cavity was accomplished through laparoscopic camera without the ability to detect the small needle. We used the retrieval device of the magnetic Double-J stent that consists of Tiemann-type with 15F diameter and magnet through one of the working ports and started to scan the abdominal cavity in systemic way under supervision of the laparoscopic camera. This magnetic retrieval device is semifixable that does not damage the intra-abdominal organs and has a strong magnetic power that can attach with metallic foreign bodies such needles efficiently. Results and Conclusion: The lost small needle was retrieved easily and safely without the need for conversion to open surgery or exposure to radiation. The innovative technique of using the magnetic retrieval device of Double-J stents as an intracorporeal laparoscopic device can be a valid and safe alternative in the retrieval of small metallic objects such as needles. Source of the study: A clinical case was encountered during practice. No competing financial interests exist. Runtime of video: 3 mins 54 secs