title: Laparoscopic needle-retrieval device for improving quality of care in minimally invasive surgery.
abstract: BACKGROUND
  Loss of a needle during laparoscopic surgery is a rare but potentially serious adverse event that can cause prolonged operative time and patient harm. Standard recovery techniques currently include instrument count, standard visual search, and plain abdominal x-rays. We developed a laparoscopic instrument to speed the retrieval of lost needles in the abdomen and pelvis.
  
  
  METHODS
  We performed in vivo testing of a novel articulating laparoscopic magnet in a porcine model. Three experienced surgeons and 3 inexperienced surgeons conducted 116 needle-retrieval trials with the device and 58 trials with a standard visual approach. Surgeons were blind to the locations of randomly placed surgical needles within the abdominal cavity. Time to recovery was measured and capped at 15 minutes. Analysis was performed using univariate and multivariable methods.
  
  
  RESULTS
  The magnetic device was able to retrieve needles significantly faster than the standard approach (2.9 ± 4.0 minutes vs 8.0 ± 6.0 minutes; p < 0.0001). On multivariable analysis, faster recovery time remained independently significant when controlling for surgeon experience, needle size (small, medium, or large), and needle location (by quadrant) (p < 0.0001). There were 2 (2%) injuries to abdominal organs during the device trials and 4 (7%) injuries during the standard trials (p = 0.182).
  
  
  CONCLUSIONS
  Recovery of lost surgical needles during porcine laparoscopic surgery is safe and feasible with a simple articulating magnetic device. Our initial in vivo experience suggests that recovery is markedly faster using the magnetic device than the standard approach, even in the hands of experienced laparoscopic surgeons. This device will be particularly useful as minimally invasive robotic and single-site surgical techniques are adopted and, in the future, it should be integrated into the standard protocol for locating lost needles during surgery.
authors.affiliation: Department of Urology, Mount Sinai School of Medicine, New York, NY 10029, USA.
authors.forename: Alexander C
authors.initials: AC
authors.lastname: Small
authors.forename: Daniel M
authors.initials: DM
authors.lastname: Gainsburg
authors.forename: Miguel A
authors.initials: MA
authors.lastname: Mercado
authors.forename: Richard E
authors.initials: RE
authors.lastname: Link
authors.forename: Sean P
authors.initials: SP
authors.lastname: Hedican
authors.forename: Michael A
authors.initials: MA
authors.lastname: Palese
mesh_terms: D000005:Abdomen / Q000601:surgery; D000818:Animals; D020878:Device Removal / Q000295:instrumentation* / Q000592:standards*; D004867:Equipment Design; D010535:Laparoscopy / Q000592:standards*; D016015:Logistic Models; D059346:Magnets; D019060:Minimally Invasive Surgical Procedures / Q000592:standards*; D023421:Models, Animal; D009339:Needles; D058996:Quality Improvement; D013552:Swine