title: A protocol to recover needles lost during minimally invasive surgery.
abstract: OBJECTIVE
  The loss of an instrument during a surgical procedure is a potentially dangerous medical event. Retained surgical needles are reported to cause chronic pain, chronic irritation, and organ injury. Surgical needles lost during minimally invasive surgery are particularly difficult to retrieve because of their diminutive size and the camera's limited visual field, often prompting protracted recovery attempts that can add to surgical costs. Few detailed recommendations exist for the recovery of a misplaced needle.
  
  
  METHODS
  A survey was administered to minimally invasive surgeons across the United States to glean observations on the incidence of lost surgical needles and recovery techniques. Survey results were incorporated into an evidence-based protocol designed to expedite the recovery of lost surgical needles.
  
  
  RESULTS
  Three hundred five minimally invasive surgeons from 11 surgical subspecialties completed the survey. Sixty-four percent of participants reported having experienced a lost surgical needle, with a minimum of 112 needles lost during the past 1 year alone. Urologists, pediatric surgeons, and bariatric surgeons reported higher rates of needle loss than surgeons practicing other subspecialties (P = .001). Removal of a needle through a minimally invasive port and laparoscopic suturing were the 2 most common situations resulting in lost needles. A systematic visual search, abdominal radiography, fluoroscopy, and the use of a magnetic retriever were reported as the most successful strategies for needle recovery.
  
  
  CONCLUSIONS
  On the basis of survey results and current literature, our protocol incorporates a camera survey of the abdomen, intraoperative fluoroscopic radiography, port inspection, and a quadrant-based systematic visual search for the recovery of needles lost during minimally invasive surgery.
authors.affiliation: Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
authors.forename: Rajiv
authors.initials: R
authors.lastname: Jayadevan
authors.affiliation: Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
authors.forename: Kristian
authors.initials: K
authors.lastname: Stensland
authors.affiliation: Department of Urology, Columbia University Medical Center, New York, NY, USA.
authors.forename: Alexander
authors.initials: A
authors.lastname: Small
authors.affiliation: Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
authors.forename: Simon
authors.initials: S
authors.lastname: Hall
authors.affiliation: Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
authors.forename: Michael
authors.initials: M
authors.lastname: Palese
mesh_terms: D000005:Abdomen; D020878:Device Removal / Q000379:methods*; D005471:Fluoroscopy; D005547:Foreign Bodies / Q000175:diagnosis / Q000601:surgery*; D006801:Humans; D019060:Minimally Invasive Surgical Procedures / Q000009:adverse effects* / Q000295:instrumentation; D009339:Needles / Q000009:adverse effects*; D011860:Radiography, Abdominal
keywords: Minimally invasive surgery; Protocol; Retrieval; Surgical needle