Surgical Items Research Articles

Detection of a Gossypiboma as a Retrocardiac Mass in a Female Patient with a History of Coronary Artery Bypass Graft

Introduction: "Gossypiboma," also known as "textiloma," refers to retained surgical items left in the body after an operation. These retained items can lead to a range of issues, from asymptomatic cases to life-threatening complications. Diagnostically challenging, gossypibomas can mimic malignant masses, making it essential to consider them in the differential diagnosis of postoperative patients with unexplained symptoms. Imaging is crucial for detection and management. Case Presentation: A 69-year-old female with a history of coronary artery bypass graft (CABG) surgery presented with exertional shortness of breath. Imaging revealed a large mass near the left atrium. Initially suspected to be a tumor, further investigation identified it as retained surgical gauze from her surgery ten years prior. Despite the mass, the patient exhibited only mild symptoms, and given her stable condition, regular follow-ups were recommended. Conclusions: Gossypibomas are rare but serious complications that may surface years after surgery. This case highlights the importance of meticulous surgical practices and careful postoperative monitoring. It underscores the need for accurate gauze counting and effective communication in the operating room to prevent errors that can lead to health risks and potential legal issues.

Gossypiboma with enterocutaneous fistula after cesarean section: a case report and review of the literature

IntroductionAlthough precautions taken for surgical procedures are strict and effective in most operative theaters, the incidence of retained foreign bodies following surgery has a reported rate of 0.01–0.001%, of which gossypibomas make up 80% of cases.Case presentationA 42-year-old woman who was Oromo in ethnicity came to the hospital with symptoms of infection, including pus drainage from her lower abdominal incision, fever, chills, and weight loss. Tests indicated an intraabdominal mass consistent with a foreign body from a previous surgery. An exploratory laparotomy revealed a surgical pack causing intestinal perforations. The foreign body was removed, and the patient recovered well postoperatively.ConclusionRetained surgical items are serious problems of surgical operations that can result in morbidity and mortality. Therefore, it should be among the differential diagnoses of any abdominal pain in patients having a history of prior surgery.

Development of the scoliosis research society spinal deformity surgery safety checklist.

Spine deformity surgery is a complex multi-step procedure that has a relatively high complication rate. The use of surgical safety checklists has been shown to reduce perioperative adverse events, but existing lists are varied and non-specific for spinal deformity surgery. Thus, the purpose of this study was to develop a comprehensive surgical checklist for complex spinal corrective surgery. An electronic survey consisting of 187 surgical checklist items that had been developed and used by a group of SRS members over a 5-year period was distributed to the Scoliosis Research Society Safety and Value Committee membership. The survey sections included: (1) pre-operative area, (2) initial operating room visit, (3) before turning, (4) positioning, (5) prepare and drape, (6) pre-incision timeout, (7) intraoperative, (8) finishing implant placement and confirming imaging, (9) final rods and locking, (10) prior to closure, (11) closure, (12) turn to supine, and (13) checkout/debriefing. Respondents graded each item on a five-point Likert scale based on their perceived importance and feasibility for inclusion in the checklist. Features graded as "moderately important" or "very important" to include by at least 70% of respondents were considered to meet the cutoff for inclusion-based standard Delphi practices. Study data were collated using REDCap. A total of 25 surgeons completed the survey in its entirety. The overall checklist "package" was shortened to 9 individual checklist modules, with 2 to 16 items per checklist. In terms of individual checklist items, 40% of items (74 of 187) met the cutoff for inclusion; 17 of these items were graded as "very important," which included verifying the presence of implantable devices, reviewing the surgical plan and positioning with the surgical staff, securing the endotracheal tube, bite block confirmation, prone and lateral positioning, neuromonitoring baseline readings, double-checking that the implant screw caps were locked prior to closure, and confirming that the patient was moving bilateral lower extremities before leaving the operating room when possible. This study has led to the development of a specific spinal deformity surgical checklist of 74 (many specific to spine surgery) items that were considered important for inclusion; 17 were considered "very important".

WP6.1 - A survey of the estimated cost of surgical consumable items within Ear, Nose, Throat departments

Abstract Aims Studies suggest that practitioners lack knowledge on cost of consumables and fail to appreciate the financial consequences of waste. We aimed to investigate this claim amongst ENT practitioners. Methods An online questionnaire, requiring cost estimations for 20 consumable items, was distributed to London ENT departments. Each item’s actual cost was compared with the average, median and interquartile range of the estimated price. An estimate was deemed ‘correct’ if it was within 20% of the actual price. Results 10.65% of all estimations were ‘correct’. There was no correlation between job role and cost-estimation accuracy. The most accurately estimated item was ‘fenestrated sterile drape’ (24.4%), the least was ‘1L bag of IV normal saline’ and ‘package of sterile sponges’ (0%). Conclusions We found poor cost appreciation of consumables amongst ENT surgeons. This could serve as a catalyst for the inclusion of health economics in specialty training curricula, improving cost-awareness.

The “6th R” of sustainability: Repurposing operating room waste for community benefit

BackgroundOperating rooms contribute greatly to hospital waste and greenhouse gas production. Efforts to “green the operating room” have focused on the 5R's of sustainability: reduce, reuse, recycle, rethink, and research. We propose a “6th R” —repurposing— as simple yet effective means of addressing operating room waste. MethodsClean, non-reusable surgical supplies were collected from a satellite facility of a children's hospital during a six-week pilot program. Materials were catalogued and repurposed throughout the community. The potential financial benefits were estimated based upon the value of repurposed goods and savings from reduced waste disposal. ResultsOver 960 items were collected during the 6-week pilot. Materials ranging from plastic trays to surgical towels were donated to organizations throughout the community. Approximate retail value of repurposed items was over $1200. When extrapolated to the entire hospital system, these repurposing efforts could account for over $50,000 in donations and $1300 in operational savings over a calendar year. ConclusionsRepurposing unused surgical items provide environmental, societal, and financial benefits, all while promoting more sustainable healthcare systems.

Unintentionally retained lap sponge mimicking an ovarian cyst two years after Caesarean section in a 37-year old patient: case report of a rare “never event” in Sudan

IntroductionThis case report reports an unusual occurrence of gossypiboma, which refers to the accidental retention of surgical materials like sponges in the peritoneal cavity. The term is derived from “gossypium” (cotton) and “boma” (place of concealment). Its incidence varies with surgical type, posing diagnostic challenges due to nonspecific symptoms and equivocal imaging. Despite its rarity, gossypiboma poses significant risks, including intestinal obstruction and abscess formation.Case presentationA 37-year-old woman with ten previous pregnancies and an emergent caesarean section presented with abdominal pain. Examination and ultrasound suggested an ovarian cyst. During surgery, a 10 × 10 cm gauze-filled mass adherent to the ovary and jejunum was found. Postoperatively, she recovered well with no complications. The patient was treated with intravenous fluids and antibiotics for five days post-surgery and recovered without any complications. She was discharged from the hospital five days after the procedure.ConclusionTo the best of our knowledge, this is the first reported case of gossypiboma in Sudan in 2024, highlighting diagnostic challenges and the need for preventive protocols. Root cause analysis of accidents, enhanced training, application of advanced technologies and a collaborative culture in the operating room can prevent the occurrence of such incidents. This case underscores the importance of meticulous surgical protocols and continuous improvement in safety measures to prevent retained surgical items, ensuring patient safety and optimal outcomes.

Stop the Line: Interventions to Prevent Retained Surgical Items.

The surgical team works collaboratively to prevent the occurrence of retained surgical items (RSIs). The purpose of this quality improvement project was to increase compliance with facility policies and improve teamwork skills to prevent the occurrence of RSIs. The project team implemented an evidence-based communication protocol, updated hospital network policies, introduced just-in-time job aids, and facilitated leader support through a daily huddle to address identified practice gaps. The TeamSTEPPS Teamwork Attitudes Questionnaire was used to measure the change in staff members' attitudes about teamwork before and after project implementation. Additional process and outcome measures included the number of near misses and actual RSIs, compliance with the daily huddle, and completion of the communication training. Results included improved perceived teamwork attitude scores and zero reports of actual RSI events over 7.5weeks.

Artificial intelligence model for automated surgical instrument detection and counting: an experimental proof-of-concept study

BackgroundRetained surgical items (RSI) are preventable events that pose a significant risk to patient safety. Current strategies for preventing RSIs rely heavily on manual instrument counting methods, which are prone to human error. This study evaluates the feasibility and performance of a deep learning-based computer vision model for automated surgical tool detection and counting.MethodsA novel dataset of 1,004 images containing 13,213 surgical tools across 11 categories was developed. The dataset was split into training, validation, and test sets at a 60:20:20 ratio. An artificial intelligence (AI) model was trained on the dataset, and the model’s performance was evaluated using standard object detection metrics, including precision and recall. To simulate a real-world surgical setting, model performance was also evaluated in a dynamic surgical video of instruments being moved in real-time.ResultsThe model demonstrated high precision (98.5%) and recall (99.9%) in distinguishing surgical tools from the background. It also exhibited excellent performance in differentiating between various surgical tools, with precision ranging from 94.0 to 100% and recall ranging from 97.1 to 100% across 11 tool categories. The model maintained strong performance on a subset of test images containing overlapping tools (precision range: 89.6–100%, and recall range 97.2–98.2%). In a real-time surgical video analysis, the model maintained a correct surgical tool count in all non-transition frames, with a median inference speed of 40.4 frames per second (interquartile range: 4.9).ConclusionThis study demonstrates that using a deep learning-based computer vision model for automated surgical tool detection and counting is feasible. The model’s high precision and real-time inference capabilities highlight its potential to serve as an AI safeguard to potentially improve patient safety and reduce manual burden on surgical staff. Further validation in clinical settings is warranted.

A Survey of the Estimated Cost of Surgical Consumable Items Within Trauma and Orthopaedic Departments.

Introduction The impact of the current economic and environmental climate, both nationally and globally, is further straining the NHS. This has led to scrutiny of high-expenditure areas, including consumables. Clinician's knowledge surrounding health economics is sparse, and we conducted this survey to assess cost-awareness within the Trauma and Orthopaedic (T&O) departmental staff. Methods A questionnaire was digitally distributed to T&O staff in the East Kent Hospitals Trust. This included demographic data and to make estimations of the cost of 10 specialty-specific items. The data were analysed to determine the average, median, and interquartile range (IQR) of the estimated prices and compared to the actual costs. Results Approximately 7.1% of all item estimates were deemed 'correct'. No correlation was seen between years of staff experience and the accuracy of estimates. 'Kenalog 1 mL ampoule' (Kenalog, Bristol-Myers Squibb, NJ) had the highest accuracy of estimation across all responses (13%), whilst both 'kirschner wires' and '3.2 drill bit' had the lowest accuracy (4% each). The median estimated cost was closest to the actual cost for 'cement pack' (median estimate/actual cost = 0.9). The median estimated cost was furthest from the actual cost for 'tourniquet cuffs' (median estimate/actual cost = 0.16). 'Velcro wrist splint' was the item that was the most overestimated (median estimate/actual cost = 1.57), with only two of the 10 items being overestimated ('velcro wrist splint' and 'dynamic hip screw and plate'). The most underestimated item was 'tourniquet cuffs' (median estimate/actual cost = 0.16). Conclusions There is a paucity of knowledge surrounding the cost of specialist T&O consumables. The limitations included the sample size (98 respondents) and geographical area (East Kent Hospitals Trust). This study shows that there is a need for further research into this topic, with long-term outcomes, which may be beneficial both economically and environmentally.

Enhancing Healthcare Access: Drone-based Delivery of Medicines and Vaccines in hard-to-Reach Terrains of Northeastern India

Background: Ensuring efficient healthcare access in a geographically diverse country like India poses significant challenges, particularly in challenging terrains. Conventional transportation methods often encounter difficulties due to inadequate infrastructure and adverse climatic conditions, resulting in delays in medical supplies. This study aimed to assess the viability of drones for transporting various types of medical supplies across diverse geographical landscapes, also evaluating their impact on transportation time, covered distance, weight carrying capacities and safety of medical supplies. Materials and Methods: The study spanned 4 months across 19 healthcare centres across Manipur and Nagaland. Different types of drones were used for the transportation of vaccines, medications and surgical items across these centres covering terrains such as flatlands, valleys, foothills, islands and hills. Results: Drones were able to successfully transport the medical supplies maintaining the essential temperatures and integrity of the samples. Further, drone-based supplies significantly reduce the delivery time compared to conventional road-based delivery mechanisms. Conclusion: The present study demonstrates the potential application of drones for the delivery of healthcare supplies in remote areas. Despite the logistical challenges, drones offer a time-efficient alternative for medical supply delivery. However, there is a need for further research and logistical infrastructure development in the current field.

Preventing an Unintentionally Retained Surgical Item.

Preventing an Unintentionally Retained Surgical Item.

Gossypiboma larynx: a rare cause of post-tracheostomy stridor—case report and review of literature

BackgroundGossypiboma, a retained surgical sponge with a foreign body reaction, is an unusual but serious complication seen in open abdominal surgeries. It is exceptionally rare following head and neck surgeries. Here, we present a case of Gossypiboma of the upper airway following tracheostomy.Case presentationA 32-year-old male presented with stridor and difficulty breathing one-month post-tracheostomy after a severe head injury following a road traffic accident. A neck radiograph was unremarkable, and a computed tomography (CT) scan of the neck showed a well-defined homogenous curvilinear membrane extending from the hypopharynx to the upper trachea. Bronchoscopic evaluation of the larynx and upper trachea revealed a retained surgical sponge, which was retrieved. The patient’s breathing improved drastically post intervention.ConclusionGossypiboma may go undetected in radiographs and may also present atypically as a homogenous membrane on a CT scan of the neck. Though rare, retained surgical items can have profound medicolegal and professional consequences on physicians. Hence, a strong clinical suspicion and vigilance for gossypiboma is necessary for patients presenting with respiratory distress post-tracheostomy.

‘The left behind syndrome’—surgical equipment errors in plastic surgery

The author discusses surgical items accidentally left behind in patients after plastic surgery, things that increase the risk of this happening and ways to reduce the risk.

Spontaneous elimination of gossypiboma: A case report

Introduction: The term gossypiboma refers to surgical items of textile matrix inadvertently left inside cavities after closure of the surgical wound. The unrecognized presence of a foreign body of any kind in the abdominal cavity after an operation is a situation rarely reported in the medical literature and surrounded by a potential for serious complications, which can evolve into a fatality. This article is an observational and descriptive case report. The information was collected by reviewing the medical records and photographic records of the surgical procedures the patient underwent. It aims to present a case of spontaneous elimination of gossypoma in a patient who had undergone a previous caesarean section. Report: Patient R.T.T.S, 17 years old, female, previously healthy, with sporadic diffuse abdominal pain for 10 months after caesarean section, with progressive worsening. One week ago, she had a significant worsening of the pain associated with constipation, difficulty in evacuating and, one day ago, anal elimination of contents similar to vegetable loofah (SIC). Physical examination revealed a slight bulge in the hypogastric region and rectal elimination of a foreign body. Discussion: Imaging methods are important allies in identifying this type of problem. The surgical approach adopted will depend on the clinical and radiological presentation of the gossypiboma. In the case reported here, we opted for rectal removal of the foreign body while preserving the integrity of the abdominal cavity, as the patient had no symptoms of abscess or fistulae. She evolved in the post-operative period in good clinical condition. Cases like this are increasingly reinforcing the need to adopt and strictly comply with checklists prior to surgery and at the end of surgery. In order to provide safe surgeries with excellence for patients in any institution in the country.

Hysteroscopic Removal of an Unwanted Remainder in the Uterus after Two Years of Caesarean Section: A Case Report of Gossypiboma

BACKGROUND: Retained surgical items (RSIs) constitute a rare complication arising after surgical procedures. Their occurrence may be averted through diligent precautionary measures. Perioperative counting of equipment and materials is the most common method of screening for RSIs. Subsequent confirmation of the diagnosis can be achieved through clinical examination and imaging studies. CASE: We report a case of successful hysteroscopic identification and retrieval of gauze inadvertently left within the uterine cavity, after a cesarean section two years back. The patient was later diagnosed with RSIs during routine evaluation for secondary subfertility and vaginal discharge. CONCLUSIONS: Despite the relatively low incidence of RSIs, they represent a significant and preventable source of patient harm, carrying the potential for fatal outcomes and resulting in substantial medical and legal expenditures.

Clinical Validation of Computer-Aided Diagnosis Software for Preventing Retained Surgical Sponges.

We previously reported the successful development of a computer-aided diagnosis (CAD) system for preventing retained surgical sponges with deep learning using training data, including composite and simulated radiographs. In this study, we evaluated the efficacy of the CAD system in a clinical setting. A total of 1,053 postoperative radiographs obtained from patients 20 years of age or older who underwent surgery were evaluated. We implemented a foreign object detection application software on the portable radiographic device used in the operating room to detect retained surgical sponges. The results of the CAD system diagnosis were prospectively collected. Among the 1,053 images, the CAD system detected possible retained surgical items in 150 images. Specificity was 85.8%, which is similar to the data obtained during the development of the software. The validation of a CAD system using deep learning in a clinical setting showed similar efficacy as during the development of the system. These results suggest that the CAD system can contribute to the establishment of a more effective protocol than the current standard practice for preventing the retention of surgical items.

A prescription for efficiency: optimizing the surgical item inventory management practices in a healthcare facility

PurposeThe primary objective of this article is to examine current procurement, inventory control and management practices in modern healthcare, with a particular focus on the procurement and management of surgical supplies in a prominent public, highly specialized healthcare sector.Design/methodology/approachThis study was conducted in three phases. In Phase 1, the study team interacted with various hospital management stakeholders, including the surgical hospital store, examined the current procurement process and identified challenges. Phase 2 focused on selecting items for a detailed study and collected the qualitative and quantitative details of the store department of the healthcare sector chosen. A detailed study analyzed revenue, output/demand, inventory levels, etc. In Phase 3, a decision-making framework is proposed, and inventory control systems are redesigned and demonstrated for the selected items.FindingsIt was observed that the demand for many surgical items had increased significantly over the years due to an increase in disposable/disposable items, while inventories fluctuated widely. Maximum inventory levels varied between 50 and 75%. Storage and availability were important issues for the hospital. It is assumed the hospital adopts the proposed inventory control system. In this case, the benefits can be a saving of 62% of the maximum inventory, 20% of the average stock in the system and optimal use of storage space, improving the performance and productivity of the hospital.Research limitations/implicationsThis study can help the healthcare sector administration to develop better systems for the procurement and delivery of common surgical items and efficient resource allocation. It can help provide adequate training to store staff. This study can help improve management/procurement policies, ordering and delivery systems, better service levels, and inventory control of items in the hospital business context. This study can serve as a pilot study to further investigate the overall hospital operations.Practical implicationsThis study can help the healthcare sector administration develop better systems for procuring and delivering common surgical items and efficient resource allocation. It can help provide adequate training to store staff. This study can help improve management/procurement policies, ordering and delivery systems, better service levels and inventory control of items in the hospital business context. This study can serve as a pilot study to further investigate the overall hospital operations.Originality/valueThis study is an early attempt to develop a decision framework and inventory control system from the perspective of healthcare inventory management. The gaps identified in real hospital scenarios are investigated, and theoretically based-inventory management strategies are applied and proposed.

Utility of real-time 3D visualization system in the early stage of phacoemulsification training.

To determine the teaching effects of a real-time three dimensional (3D) visualization system in the operating room for early-stage phacoemulsification training. A total of 10 ophthalmology residents of the first-year postgraduate were included. All the residents were novices to cataract surgery. Real-time cataract surgical observations were performed using a custom-built 3D visualization system. The training lasted 4wk (32h) in all. A modified International Council of Ophthalmology's Ophthalmology Surgical Competency Assessment Rubric (ICO-OSCAR) containing 4 specific steps of cataract surgery was applied. The self-assessment (self) and expert-assessment (expert) were performed through the microsurgical attempts in the wet lab for each participant. Compared with pre-training assessments (self 3.2±0.8, expert 2.5±0.6), the overall mean scores of post-training (self 5.2±0.4, expert 4.7±0.6) were significantly improved after real-time observation training of 3D visualization system (P<0.05). Scores of 4 surgical items were significantly improved both self and expert assessment after training (P<0.05). The 3D observation training provides novice ophthalmic residents with a better understanding of intraocular microsurgical techniques. It is a useful tool to improve teaching efficiency of surgical education.

A simple and practical approach to improving the cost effectiveness of surgical inventory management

ABSTRACT Operating room inventories typically involve hundreds of surgical items. Managers require very high service levels since the cost of shortages can be excessive up to and including cancelling surgery. From our experience, many inventory managers rely on manual approaches and intuition to set inventory control parameters. Although there are classical theoretical methods available for deriving “optimal” inventory policies, these classical methods rely on assumptions that do not accurately represent typical operating room inventories. Using 5 years of data from a large Canadian hospital, we use simulation and a simple search heuristic to find the optimal (s, S) ordering policy and show that 1) current hospital methods dramatically underperform with respect to service level and 2) there are significant savings to be realised over the best available classical theoretical models. An example case testing potential lead time changes is discussed.

Invited Commentary: Artificial Intelligence to the Rescue: The Unending Search for Retained Surgical Items.

Invited Commentary: Artificial Intelligence to the Rescue: The Unending Search for Retained Surgical Items.