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Washington SN, Gam K, Kim DD, Lindquist J, Lescay HA, Gundeti MS. Minimizing and managing needle and instrument loss during pediatric robotic surgery. J Pediatr Urol 2024; 20:776-777. [PMID: 38987105 DOI: 10.1016/j.jpurol.2024.06.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2024] [Revised: 05/03/2024] [Accepted: 06/07/2024] [Indexed: 07/12/2024]
Abstract
INTRODUCTION Lost objects and equipment malfunctions during robotic and laparoscopic cases can lead to an increase in operating time and potential risk to the patient. The literature on the management of foreign bodies during pediatric robotic-assisted surgery is limited. The purpose of the video is to review proper instrument handling to prevent loss of an object and to propose our technique for retrieving lost objects through two pediatric case examples. MATERIALS AND METHODS The first case is a robotic-assisted laparoscopic left pyeloplasty in a 6-week-old male with congenital uteropelvic junction obstruction during which a needle was lost. In the video, we describe our techniques for safe needle passage, proper suturing technique, and recovering a lost needle. The second case is a robotic-assisted right upper pole heminephrectomy in a 14-month-old female with a duplicated renal collecting system and hydroureteronephrosis. We present the management of a rare case during which a harmonic scalpel jaw malfunctioned leading to a lost foreign body. We describe our technique for retrieving the lost fragment. RESULTS All objects were safely removed, and patients were discharged post-op day one without complication. CONCLUSION Our video presents two case examples of foreign bodies lost during pediatric robotic surgeries and approaches to manage each of these incidents.
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Affiliation(s)
- Stephanie N Washington
- University of Chicago Pritzker School of Medicine, 924 E 57th St, Suite #104, Chicago, IL 60637, USA.
| | - Kristina Gam
- University of Chicago, Section of Urology, Comer Children's Hospital, 5841 S. Maryland Avenue, Rm. P-217, MC 7122, Chicago, IL 60637, USA
| | - David D Kim
- University of Chicago, Section of Urology, Comer Children's Hospital, 5841 S. Maryland Avenue, Rm. P-217, MC 7122, Chicago, IL 60637, USA
| | - Johnny Lindquist
- University of Chicago, Section of Urology, Comer Children's Hospital, 5841 S. Maryland Avenue, Rm. P-217, MC 7122, Chicago, IL 60637, USA
| | - Hernan A Lescay
- University of Chicago, Section of Urology, Comer Children's Hospital, 5841 S. Maryland Avenue, Rm. P-217, MC 7122, Chicago, IL 60637, USA
| | - Mohan S Gundeti
- University of Chicago, Section of Urology, Comer Children's Hospital, 5841 S. Maryland Avenue, Rm. P-217, MC 7122, Chicago, IL 60637, USA
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Rodríguez-Alcalá L, Valderrama-Penagos JX, O'Connor-Garcia St E, O'Connor-Reina C. Lost needle in the oral cavity: can the nightmare be just a bad dream? J Laryngol Otol 2024:1-4. [PMID: 38314758 DOI: 10.1017/s0022215124000264] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2024]
Abstract
OBJECTIVE The loss of a scalpel or a needle during surgery can threaten the health of the patient and lead to additional costs, and radiographical assistance during surgery has been the only recovery method. This study evaluates the efficacy of a metal detector compared with conventional radiology for recovering a needle lost in the oropharynx during surgery. METHOD Different fragment sizes of needles normally used in pharyngoplasty were embedded at different locations and depths in a lamb's head. Three experienced and three junior otolaryngologists searched for the needle fragments using a metal detector and conventional radiology. RESULTS All fragments were found with each method, but the mean searching time was 90 per cent shorter with the metal detector. CONCLUSION A metal detector can be a useful tool for locating needles that break during ENT surgery, as it requires less time than conventional radiology and avoids exposing patients to radiation.
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Affiliation(s)
- Laura Rodríguez-Alcalá
- Department of Otorhinolaryngology, Hospital Quiron Salud Marbella and Hospital Quiron Salud Campo de Gibraltar, Spain
| | | | | | - Carlos O'Connor-Reina
- Department of Otorhinolaryngology, Hospital Quiron Salud Marbella and Hospital Quiron Salud Campo de Gibraltar, Spain
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Di Mento C, Chiodi A, Cerulo M, Del Conte F, Coppola V, Carulli R, Lepore B, Escolino M, Esposito C. Fantastic Needles and Where to Find Them During a Laparoscopic Nissen Fundoplication: Review of Safety Measures to Avoid Needle Loss During Minimally Invasive Surgery. Surg Laparosc Endosc Percutan Tech 2023; 33:688-690. [PMID: 37852232 DOI: 10.1097/sle.0000000000001239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Accepted: 08/31/2023] [Indexed: 10/20/2023]
Abstract
BACKGROUND Losing a needle during laparoscopic surgery may be a dramatic moment for the surgeon and potentially have clinical and medico-legal consequences. This case report aims to describe an unusual case of needle loss that occurred during laparoscopic Nissen fundoplication and how to prevent its further occurrence. METHODS The patient is an 11-year-old boy with a body mass index of 32.4 kg/m 2 . He suffered from severe gastroesophageal reflux disease not responding to medical therapy and hiatal hernia. A laparoscopic Nissen fundoplication was performed. RESULTS At the closure of the Nissen wrap, CO 2 leakage through the umbilical trocar caused the needle lost during the introduction of the thread. We attempted to find the needle by exploring the entire abdominal cavity without success. Therefore, we decided to complete the surgical procedure. Another 2/0 nonresorbable thread was inserted in the same way as before. But this suture also disappeared. Hence, we manually straightened the needle and introduced it under vision. The operation was accomplished successfully. An intraoperative x-ray was obtained, showing the 2 needles at the level of the 12th rib, near the working port used for the liver retractor. A peritoneal window was created using a monopolar hook, allowing to finally extract the 2 hidden needles. CONCLUSION The loss of needles, although a rare event, can occur during laparoscopic surgery. Based on our experience, we suggest that needle insertion during laparoscopic operations should be performed under direct vision, especially in obese patients, to reduce the likelihood of such complications.
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Affiliation(s)
- Claudia Di Mento
- Department of Translational Medical Sciences (DISMET), Pediatric Surgery Unit, Federico II University Hospital, Naples, Italy
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George T, Buckingham M, Pandey S. Lost Needle During Gynecologic Laparoscopic Surgery: A Literature Review and a Suggested Approach. J Gynecol Surg 2023. [DOI: 10.1089/gyn.2022.0101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Affiliation(s)
- Thejus George
- St. George's Hospital Medical School, London, United Kingdom
| | | | - Suruchi Pandey
- St. George's Hospital Medical School, London, United Kingdom
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Grosshauser M, Ohletz T, Oesch V, Muller CO. Tips and Tricks—3 Use Cases of Interdisciplinary Knowledge Transfer in Minimally Invasive Pediatric Surgery. CHILDREN 2022; 9:children9091270. [PMID: 36138579 PMCID: PMC9497707 DOI: 10.3390/children9091270] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/31/2022] [Revised: 08/19/2022] [Accepted: 08/20/2022] [Indexed: 11/16/2022]
Abstract
In the pediatric surgical environment, we can enrich our knowledge and improve our skills through interdisciplinary knowledge transfer in exchange with other surgical or even non-surgical disciplines. To demonstrate this, we present in this article three patient cases of method transfer enabling new techniques in minimally invasive pediatric surgery. 1. The somewhat modified application of the AeroStat rigid tip laparoscopic cholangiography catheter during the single-step laparoscopic cholecystectomy facilitates the safe intraoperative cholangiography with common bile duct flushing. 2. A magnetic rod is used during laparoscopic enterotomy to locate and retrieve ingested magnets. 3. Using a patient-specific MRI 3D model representing a syndromic high anorectal malformation improves surgical planning and parental education.
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Affiliation(s)
- Mareike Grosshauser
- Department of Paediatric Surgery, Cantonal Hospital Aarau, Tellstrasse 25, 5000 Aarau, Switzerland
- Correspondence: ; Tel.: +41-62-838-2767
| | - Tim Ohletz
- Department of Radiology and 3D Lab, Cantonal Hospital Aarau, Tellstrasse 25, 5000 Aarau, Switzerland
| | - Valérie Oesch
- Department of Paediatric Surgery, Cantonal Hospital Aarau, Tellstrasse 25, 5000 Aarau, Switzerland
| | - Cécile Olivia Muller
- Department of Paediatric Surgery, Cantonal Hospital Aarau, Tellstrasse 25, 5000 Aarau, Switzerland
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Li Y, Xing Y, Song X, Yue X, Zhou Y, Wang Y. Diagnosis and Treatment of Needle Retention After Blepharoplasty. J Plast Reconstr Aesthet Surg 2022; 75:3877-3903. [DOI: 10.1016/j.bjps.2022.08.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Revised: 07/10/2022] [Accepted: 08/16/2022] [Indexed: 11/27/2022]
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Susmallian S, Barnea R, Azaria B, Szyper-Kravitz M. Addressing the important error of missing surgical items in an operated patient. Isr J Health Policy Res 2022; 11:19. [PMID: 35382877 PMCID: PMC8981682 DOI: 10.1186/s13584-022-00530-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Accepted: 03/26/2022] [Indexed: 11/24/2022] Open
Abstract
Background We aim to analyze the characteristics of incidences of missing surgical items (MSIs) and to examine the changes in MSI events following the implementation of an MSI prevention program. Methods All surgical cases registered in our medical center from January 2014 to December 2019 were retrospectively analyzed. Results Among 559,910 operations, 154 MSI cases were reported. Mean patient age was 48.67 years (standard deviation, 20.88), and 56.6% were female. The rate of MSIs was 0.259/1000 cases. Seventy-seven MSI cases (53.10%) had no consequences, 47 (32.41%) had mild consequences, and 21 (14.48%) had severe consequences. These last 21 cases represented a rate of 0.037/1000 cases. MSI events were more frequent in cardiac surgery (1.82/1000 operations). Textile elements were the most commonly retained materials (28.97% of cases). In total, 15.86% of the cases were not properly reported. The risk factors associated with MSIs included body mass index (BMI) above 35 kg/m2 and prolonged operative time. After the implementation of the institutional prevention system in January 2017, there was a gradual decrease in the occurrence of severe events despite an increase in the number of MSIs. Conclusion Despite the increase in the rate of MSIs, an implemented transparency and reporting system helped reduce the cases with serious consequences. To further prevent the occurrence of losing surgical elements in a surgery, we recommend educating OR staff members about responsibility and obligation to report all incidents that are caused during an operation, to develop an event reporting system as well as "rituals" within the OR setting to increase the team's awareness to MSIs. Trial registration Clinicaltrials.gov (NCT04293536). Date of registration: 08.01.2021. https://clinicaltrials.gov/ct2/show/NCT04293536.
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Affiliation(s)
- Sergio Susmallian
- Department of Surgery, Assuta Medical Center, 20 Habarzel Street, 69710, Tel Aviv, Israel. .,Faculty of Medicine, Ben Gurion University of the Negev, Beer Sheva, Israel.
| | - Royi Barnea
- Assuta Health Services Research Institute, Assuta Medical Center, Tel-Aviv, Israel.,School of Health Systems Management at Netanya Academic College, Netanya, Israel
| | - Bella Azaria
- Medicine Division, Assuta Medical Center, Tel Aviv, Israel
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Ramot Y, Rousselle S, Steiner M, Lavie Y, Ezov N, Nyska A. Safety and Performance Evaluation of Su2ura Approximation, a New Suturing Device, in Pigs. Toxicol Pathol 2021; 50:211-217. [DOI: 10.1177/01926233211067960] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
One of the challenging aspects of minimal invasive surgery (MIS) is intracorporal suturing, which can be significantly time-consuming. Therefore, there is a rising need for devices that can facilitate the suturing procedure in MIS. Su2ura Approximation Device (Su2ura Approximation) is a novel device developed to utilize the insertion of anchors threaded with stitches to allow a single action placement of a suture. The objective of this study was to evaluate the long-term safety and tissue approximation of Su2ura Approximation in comparison to Endo Stitch + Surgidac sutures in female domestic pigs. All incision sites were successfully closed by both methods. Firm consolidation within and around the incision site was noted in several animals in both treatment groups, which corresponded histopathologically to islands of ectopic cartilage or bone spicules within the fibrotic scar. These changes reflect heterotopic ossification that is commonly seen in the healing of abdominal operation sites in pigs. No other abnormal findings were observed throughout the study period. In conclusion, the use of Su2ura Approximation under the present experimental conditions revealed no safety concerns.
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Affiliation(s)
- Yuval Ramot
- Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
- Department of Dermatology, Hadassah Medical Center, Jerusalem, Israel
| | | | | | | | - Nati Ezov
- Envigo CRS (Israel), Ness Ziona, Israel
| | - Abraham Nyska
- Toxicologic Pathology, Tel Aviv and Tel Aviv University, Tel Aviv, Israel
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Gulack BC, Skertich NJ, Sullivan GA, Shah AN, Zani A. The lost suture needle: An algorithm to standardize management and improve outcomes. J Pediatr Surg 2021; 56:2128-2129. [PMID: 34420800 DOI: 10.1016/j.jpedsurg.2021.07.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Accepted: 07/22/2021] [Indexed: 11/25/2022]
Affiliation(s)
- Brian C Gulack
- Department of Surgery, Rush University Medical Center, 1653 W Congress Parkway, Kellogg 7, Chicago, IL USA 60612.
| | - Nicholas J Skertich
- Department of Surgery, Rush University Medical Center, 1653 W Congress Parkway, Kellogg 7, Chicago, IL USA 60612
| | - Gwyneth A Sullivan
- Department of Surgery, Rush University Medical Center, 1653 W Congress Parkway, Kellogg 7, Chicago, IL USA 60612
| | - Ami N Shah
- Department of Surgery, Rush University Medical Center, 1653 W Congress Parkway, Kellogg 7, Chicago, IL USA 60612
| | - Augusto Zani
- Division of General and Thoracic Surgery, The Hospital for Sick Children, 555 University Ave, Suite 1526, Toronto, ON Canada M5G1 × 8
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Watrowski R, Kostov S, Alkatout I. Complications in laparoscopic and robotic-assisted surgery: definitions, classifications, incidence and risk factors - an up-to-date review. Wideochir Inne Tech Maloinwazyjne 2021; 16:501-525. [PMID: 34691301 PMCID: PMC8512506 DOI: 10.5114/wiitm.2021.108800] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2021] [Accepted: 06/30/2021] [Indexed: 11/26/2022] Open
Abstract
Almost all gynecological and general-surgical operations are - or can be - performed laparoscopically. In comparison to an abdominal approach, the minimally invasive access offers several advantages; however, laparoscopy (both conventional and robotic-assisted) can be associated with a number of approach-specific complications. Although the majority of them are related to the laparoscopic entry, adverse events may also occur due to the presence of pneumoperitoneum or the use of laparoscopic instruments. Unfortunately, a high proportion of complications (especially affecting the bowel and ureter) remain unrecognized during surgery. This narrative review provides comprehensive up-to-date information about definitions, classifications, risk factors and incidence of surgical complications in conventional and robotic-assisted laparoscopy, with a special focus on gynecology. The topic is discussed from various perspectives, e.g. in the context of stage of surgery, injured organs, involved instruments, and in relation to malpractice claims.
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Affiliation(s)
- Rafał Watrowski
- St. Josefskrankenhaus, Teaching Hospital of the University of Freiburg, Freiburg, Germany
| | - Stoyan Kostov
- Department of Gynecology, Medical University Varna, Varna, Bulgaria
| | - Ibrahim Alkatout
- Department of Gynecology and Obstetrics, Kiel School of Gynecological Endoscopy, University Hospitals Schleswig-Holstein, Kiel, Germany
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Weprin S, Crocerossa F, Meyer D, Maddra K, Valancy D, Osardu R, Kang HS, Moore RH, Carbonara U, J Kim F, Autorino R. Risk factors and preventive strategies for unintentionally retained surgical sharps: a systematic review. Patient Saf Surg 2021; 15:24. [PMID: 34253246 PMCID: PMC8276389 DOI: 10.1186/s13037-021-00297-3] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Accepted: 05/13/2021] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND A retained surgical item (RSI) is defined as a never-event and can have drastic consequences on patient, provider, and hospital. However, despite increased efforts, RSI events remain the number one sentinel event each year. Hard foreign bodies (e.g. surgical sharps) have experienced a relative increase in total RSI events over the past decade. Despite this, there is a lack of literature directed towards this category of RSI event. Here we provide a systematic review that focuses on hard RSIs and their unique challenges, impact, and strategies for prevention and management. METHODS Multiple systematic reviews on hard RSI events were performed and reported using PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) and AMSTAR (Assessing the methodological quality of systematic reviews) guidelines. Database searches were limited to the last 10 years and included surgical "sharps," a term encompassing needles, blades, instruments, wires, and fragments. Separate systematic review was performed for each subset of "sharps". Reviewers applied reciprocal synthesis and refutational synthesis to summarize the evidence and create a qualitative overview. RESULTS Increased vigilance and improved counting are not enough to eliminate hard RSI events. The accurate reporting of all RSI events and near miss events is a critical step in determining ways to prevent RSI events. The implementation of new technologies, such as barcode or RFID labelling, has been shown to improve patient safety, patient outcomes, and to reduce costs associated with retained soft items, while magnetic retrieval devices, sharp detectors and computer-assisted detection systems appear to be promising tools for increasing the success of metallic RSI recovery. CONCLUSION The entire healthcare system is negatively impacted by a RSI event. A proactive multimodal approach that focuses on improving team communication and institutional support system, standardizing reports and implementing new technologies is the most effective way to improve the management and prevention of RSI events.
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Affiliation(s)
- Samuel Weprin
- Division of Urology, Department of Surgery, VCU Health, Richmond, VA, 23298-0118, USA
| | - Fabio Crocerossa
- Division of Urology, Department of Surgery, VCU Health, Richmond, VA, 23298-0118, USA
- Division of Urology, Magna Graecia University of Catanzaro, Catanzaro, Italy
| | - Dielle Meyer
- Division of Urology, Department of Surgery, VCU Health, Richmond, VA, 23298-0118, USA
| | - Kaitlyn Maddra
- Division of Urology, Department of Surgery, VCU Health, Richmond, VA, 23298-0118, USA
| | - David Valancy
- Division of Urology, Department of Surgery, VCU Health, Richmond, VA, 23298-0118, USA
| | - Reginald Osardu
- Division of Urology, Department of Surgery, VCU Health, Richmond, VA, 23298-0118, USA
| | - Hae Sung Kang
- Division of Urology, Department of Surgery, VCU Health, Richmond, VA, 23298-0118, USA
| | - Robert H Moore
- Division of Urology, Department of Surgery, VCU Health, Richmond, VA, 23298-0118, USA
| | - Umberto Carbonara
- Division of Urology, Department of Surgery, VCU Health, Richmond, VA, 23298-0118, USA
- Dept of Urology, Andrology and Kidney Transplantation Unit, University of Bari, Bari, Italy
| | - Fernando J Kim
- Division of Urology Denver Health Medical Center and University of Colorado Anschutz Medical Center, Colorado, Denver, USA
| | - Riccardo Autorino
- Division of Urology, Department of Surgery, VCU Health, Richmond, VA, 23298-0118, USA.
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Seon S, Lee BS, Choi BJ, Ohe JY, Lee JW, Jung J, Hwang BY, Kim MA, Kwon YD. Removal of a suture needle: a case report. Maxillofac Plast Reconstr Surg 2021; 43:22. [PMID: 34224020 PMCID: PMC8257847 DOI: 10.1186/s40902-021-00309-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Accepted: 06/25/2021] [Indexed: 02/05/2023] Open
Abstract
Background Foreign bodies may be embedded or left behind in the oral cavity during oral surgical procedure. The loss of instruments such as impression material, surgical gauze, and broken injection needles are commonly reported in the dental field. These complications are generally symptomatic and show signs of inflammation, pain, and purulent discharge. Accidental breakage of suture needles is a rare but potentially dangerous event. Case presentation In this report, we present one case of lost suture needle during the procedure of flap operation at local dental clinic and its successful removal under local/general anesthesia administration via CBCT with a help of two reference needles to localize the 6-0 nylon needle and consulting with the clinician. Conclusion CT scanning taken while mouth-closing may not be accurate with regard to real location measurement performed while mouth-opening. If so, other up-to-date radiographic devices and methods to retrieve a needle are recommended.
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Affiliation(s)
- Suyun Seon
- Department of Oral and Maxillofacial surgery, School of Dentistry, Kyung Hee University, 26, Kyungheedae-ro, Dongdaemun-gu, Seoul, 130-701, South Korea
| | - Baek-Soo Lee
- Department of Oral and Maxillofacial surgery, School of Dentistry, Kyung Hee University, 26, Kyungheedae-ro, Dongdaemun-gu, Seoul, 130-701, South Korea
| | - Byung-Joon Choi
- Department of Oral and Maxillofacial surgery, School of Dentistry, Kyung Hee University, 26, Kyungheedae-ro, Dongdaemun-gu, Seoul, 130-701, South Korea
| | - Joo-Young Ohe
- Department of Oral and Maxillofacial surgery, School of Dentistry, Kyung Hee University, 26, Kyungheedae-ro, Dongdaemun-gu, Seoul, 130-701, South Korea
| | - Jung-Woo Lee
- Department of Oral and Maxillofacial surgery, School of Dentistry, Kyung Hee University, 26, Kyungheedae-ro, Dongdaemun-gu, Seoul, 130-701, South Korea
| | - Junho Jung
- Department of Oral and Maxillofacial surgery, School of Dentistry, Kyung Hee University, 26, Kyungheedae-ro, Dongdaemun-gu, Seoul, 130-701, South Korea
| | - Bo-Yeon Hwang
- Department of Oral and Maxillofacial surgery, School of Dentistry, Kyung Hee University, 26, Kyungheedae-ro, Dongdaemun-gu, Seoul, 130-701, South Korea
| | - Min-Ah Kim
- Department of Oral and Maxillofacial surgery, School of Dentistry, Kyung Hee University, 26, Kyungheedae-ro, Dongdaemun-gu, Seoul, 130-701, South Korea
| | - Yong-Dae Kwon
- Department of Oral and Maxillofacial surgery, School of Dentistry, Kyung Hee University, 26, Kyungheedae-ro, Dongdaemun-gu, Seoul, 130-701, South Korea.
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Zhao Y, Chen Q, Hu JN, Shen Q, Xia L, Yan LZ, Wang Y, Zhu XJ, Li WJ, Hu Y, Zhang Q. Application of multidirectional stitching technology in a laparoscopic suturing instructional program: a randomized controlled trial. BMC MEDICAL EDUCATION 2020; 20:248. [PMID: 32753043 PMCID: PMC7409432 DOI: 10.1186/s12909-020-02146-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/09/2019] [Accepted: 07/09/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND Surgeon suturing technology plays a pivotal role in patient recovery after laparoscopic surgery. Intracorporal suturing and knot tying in minimally invasive surgery are particularly challenging and represent a key skill for advanced procedures. In this study, we compared the application of multidirectional stitching technology with application of the traditional method in a laparoscopic suturing instructional program. METHODS We selected forty residents within two years of graduation to assess the specialized teaching of laparoscopic suturing with laparoscopic simulators. The forty students were randomly divided into two groups, a control group and an experimental group, with twenty students in each group. The control group was scheduled to learn the traditional suture method, and the experimental group applied multidirectional stitching technology. The grades for suturing time, thread length, accuracy of needle entry, stability of the knot, tissue integrity, and tightness of the tissue before and after the training program were calculated. RESULTS There was no significant difference between the two groups before the learning intervention. After the program, both groups significantly improved in each subject. There were significant differences between the control group and the experimental group in suture time (P = 0.001), accuracy of needle entry and exit (P = 0.035), and whether the suture tissue had cracks (P = 0.030). However, the two groups showed non-significant differences in thread length (P = 0.093), stablity of the knot (P = 0.241), or tightness of the tissue (P = 0.367). CONCLUSIONS Multidirectional stitching technology improves the efficiency and effectiveness of traditional laparoscopic suture instructional programs. It might be a practicable, novel training method for acquiring proficiency in manual laparoscopic skills in a training setting.
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Affiliation(s)
- Yu Zhao
- Department of Obstetrics and Gynaecology, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, 325000, China
| | - Qiong Chen
- Department of Obstetrics and Gynaecology, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, 325000, China
| | - Jia-Ning Hu
- The Second School of Medicine, Wenzhou Medical University, Wenzhou, Zhejiang, 325000, China
| | - Qi Shen
- Department of Obstetrics and Gynaecology, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, 325000, China
| | - Lu Xia
- Department of Obstetrics and Gynaecology, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, 325000, China
| | - Lin-Zhi Yan
- Department of Obstetrics and Gynaecology, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, 325000, China
| | - Yi Wang
- Department of Obstetrics and Gynaecology, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, 325000, China
| | - Xiu-Jie Zhu
- Department of Obstetrics and Gynaecology, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, 325000, China
| | - Wen-Ju Li
- Department of Obstetrics and Gynaecology, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, 325000, China
| | - Yue Hu
- Department of Obstetrics and Gynaecology, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, 325000, China
| | - Qiong Zhang
- Department of Obstetrics and Gynaecology, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, 325000, China.
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Contegiacomo A, Conti M, Trombatore P, Dezio M, Muciaccia M, Lozupone E, Natale L, Manfredi R. Radiological features and management of retained needles. Br J Radiol 2020; 93:20200316. [PMID: 32516553 DOI: 10.1259/bjr.20200316] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
The identification of retained needles is essential because of their sharp structure with possible life-threatening complications. However, radiological evaluation could be challenging, especially in case of needles' relatively poor conspicuity and small dimension. This pictorial essay focuses on clinical issues (needle features, retention mechanisms and associated complications) and technical aspects (choice of the best diagnostic modality and technique) that can lead the radiologist to an earlier and proper diagnosis of needle retention in order to provide the best treatment for the patient.
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Affiliation(s)
| | - Marco Conti
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | | | | | | | - Emilio Lozupone
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Luigi Natale
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.,Università Cattolica Sacro Cuore, Rome, Italy
| | - Riccardo Manfredi
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.,Università Cattolica Sacro Cuore, Rome, Italy
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15
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Mair LO, Liu X, Dandamudi B, Jain K, Chowdhury S, Weed J, Diaz-Mercado Y, Weinberg IN, Krieger A. MagnetoSuture: Tetherless Manipulation of Suture Needles. IEEE TRANSACTIONS ON MEDICAL ROBOTICS AND BIONICS 2020; 2:206-215. [PMID: 34746679 DOI: 10.1109/tmrb.2020.2988462] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
This paper demonstrates the feasibility of ligation and tissue penetration for surgical suturing tasks using magnetically actuated suture needles. Manipulation of suture needles in minimally invasive surgery involves using articulated manual/robotic tools for needle steering and controlling needle-tissue or thread-tissue interactions. The large footprints of conventional articulated surgical tools significantly increase surgical invasiveness, potentially leading to longer recovery times, tissue damage, scarring, or associated infections. Aiming to address these issues, we investigate the feasibility of using magnetic fields to tetherlessly steer suture needles. The primary challenge of such a concept is to provide sufficient force for tissue penetration and ligation. In this work, we demonstrate proof-of-concept capabilities using the MagnetoSuture™ system, performing tissue penetration and ligation tasks using ex vivo tissues, customized NdFeB suture needles with attached threads, and remote-controlled magnetic fields. To evaluate the system performance, we conducted experiments demonstrating tetherless recreation of a purse string suture pattern, ligation of an excised segment of a rat intestine, and penetration of rat intestines.
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Affiliation(s)
- Lamar O Mair
- Weinberg Medical Physics, Inc., North Bethesda, Maryland 20852 USA
| | - Xiaolong Liu
- Department of Mechanical Engineering, University of Maryland, College Park, and the Maryland Robotics Center, College Park, Maryland 20742 USA
| | - Bhargav Dandamudi
- Department of Mechanical Engineering, University of Maryland, College Park, and the Maryland Robotics Center, College Park, Maryland 20742 USA
| | - Kamakshi Jain
- Department of Mechanical Engineering, University of Maryland, College Park, and the Maryland Robotics Center, College Park, Maryland 20742 USA
| | - Sagar Chowdhury
- Weinberg Medical Physics, Inc., North Bethesda, Maryland 20852 USA
| | - Jeremy Weed
- Department of Mechanical Engineering, University of Maryland, College Park, and the Maryland Robotics Center, College Park, Maryland 20742 USA
| | - Yancy Diaz-Mercado
- Department of Mechanical Engineering, University of Maryland, College Park, and the Maryland Robotics Center, College Park, Maryland 20742 USA
| | | | - Axel Krieger
- Department of Mechanical Engineering, University of Maryland, College Park, and the Maryland Robotics Center, College Park, Maryland 20742 USA
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16
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Eastment J, Sandstrom A, McLaren M, Byrne S, Slater K. Novel approach to a hepatic foreign body using a $5.50 magnet. ANZ J Surg 2019; 90:893-894. [PMID: 31361085 DOI: 10.1111/ans.15349] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2019] [Accepted: 06/11/2019] [Indexed: 11/30/2022]
Affiliation(s)
- Jacques Eastment
- Division of Surgery, Princess Alexandra Hospital, Brisbane, Queensland, Australia.,School of Medicine, The University of Queensland, Brisbane, Queensland, Australia
| | - Anna Sandstrom
- Division of Surgery, Princess Alexandra Hospital, Brisbane, Queensland, Australia.,School of Medicine, The University of Queensland, Brisbane, Queensland, Australia
| | - Mairi McLaren
- Division of Surgery, Princess Alexandra Hospital, Brisbane, Queensland, Australia.,School of Medicine, The University of Queensland, Brisbane, Queensland, Australia
| | - Sarah Byrne
- Division of Surgery, Princess Alexandra Hospital, Brisbane, Queensland, Australia.,School of Medicine, The University of Queensland, Brisbane, Queensland, Australia
| | - Kellee Slater
- Division of Surgery, Princess Alexandra Hospital, Brisbane, Queensland, Australia.,School of Medicine, The University of Queensland, Brisbane, Queensland, Australia
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17
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Behbehani S, Magtibay P. Minimally Invasive Approach to Surgical Removal of a Retained Broken Needle. J Minim Invasive Gynecol 2018; 26:800-801. [PMID: 30584911 DOI: 10.1016/j.jmig.2018.12.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2018] [Revised: 08/16/2018] [Accepted: 08/20/2018] [Indexed: 10/27/2022]
Affiliation(s)
- Sadikah Behbehani
- Department of Gynecological Surgery, Mayo Clinic Hospital, Phoenix, Arizona (both authors)..
| | - Paul Magtibay
- Department of Gynecological Surgery, Mayo Clinic Hospital, Phoenix, Arizona (both authors)
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18
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Moynihan M, Moinzadeh A. Retained Needle in the AirSeal Trocar During Robot-Assisted Laparoscopic Radical Prostatectomy: Lessons Learned. J Endourol Case Rep 2018; 4:105-107. [PMID: 29992187 PMCID: PMC6036700 DOI: 10.1089/cren.2018.0034] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background: Unique case of retained needle in the AirSeal trocar during robot-assisted laparoscopic radical prostatectomy. Case Presentation: A 68-year-old male with prostate cancer underwent robot-assisted laparoscopic radical prostatectomy. Upon laparoscopic removal of final intra-abdominal suture by bedside assistant, needle became dislodged from suture and was unable to be located after a standard systematic search. Ultimately, needle was found caught in the assistant's AirSeal trocar device. Conclusion: Intraoperative loss of a foreign body should include inspection, and possible radiographic evaluation, of the trocar mechanism as part of a complete systematic approach.
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19
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Ward EP, Yang J, Delong JC, Sung TW, Wang J, Barback C, Mendez N, Horgan S, Trogler W, Kummel AC, Blair SL. Identifying lost surgical needles with visible and near infrared fluorescent light emitting microscale coating. Surgery 2018; 163:883-888. [PMID: 29338879 DOI: 10.1016/j.surg.2017.10.025] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2017] [Revised: 08/04/2017] [Accepted: 10/04/2017] [Indexed: 11/25/2022]
Abstract
BACKGROUND Retained foreign bodies (RFOs) have substantial clinical and financial consequences. In laparoscopic surgery, RFOs can be a cause of needing to convert a minimally invasive surgery (MIS) procedure to an open operation. A coating for surgical models was developed to augment localization of needles using fluorescence appropriate for open and minimally invasive surgeries procedures. METHODS An epoxy matrix containing both dansyl chloride and indocyanine green was coated as visible and near infrared labels, respectively. With ultraviolet excitation, dansyl chloride emits green fluorescence and with NIR excitation, the ICG dye emits radiation observable with specialized near infrared capable laparoscopes. To evaluate the coatings, open and laproscopic surgeries were simulated in rabbits. Surgeons blinded to the type of needles (coated or non-coated) were timed while finding needles in standard conditions and with the use of the adjunct coatings. Control needles not located within 300 seconds were researched with the corresponding near infrared or ultraviolet light. Localization time was evaluated for statistical significance, P < .05. RESULTS All dual dye coated needles searched utilizing the near infrared camera (n = 26) or ultraviolet light (n= 26) were located within 300 seconds. Conversely, 9 needles in both control settings (no dye usage) were not located within 300 seconds. Mean time to locate control needles in open surgery and laparoscopic surgery was statistically 2-3× greater than time to localization with the use of dye as an adjunct (P = .0027 open, P < .001 laparoscopic). CONCLUSION Incorporation of a dual-dye fluorescent coating on surgical needles improved the efficiency of locating needles, may minimize the need to convert minimally invasive surgeries procedures to open, and may decrease the consequences of a missed RFO.
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Affiliation(s)
- Erin P Ward
- Moores Cancer Center, University of California, San Diego, CA
| | - Jian Yang
- Department of Chemistry and Biochemistry, University of California, San Diego, CA
| | | | - Tsai-Wen Sung
- Department of Nanoengineering, University of California, San Diego, CA
| | - James Wang
- Department of Nanoengineering, University of California, San Diego, CA
| | - Chris Barback
- Department of Radiology, University of California, San Diego, CA
| | - Natalie Mendez
- Department of Material Science and Engineering, University of California, San Diego, CA
| | - Santiago Horgan
- Moores Cancer Center, University of California, San Diego, CA
| | - William Trogler
- Department of Chemistry and Biochemistry, University of California, San Diego, CA
| | - Andrew C Kummel
- Department of Chemistry and Biochemistry, University of California, San Diego, CA
| | - Sarah L Blair
- Moores Cancer Center, University of California, San Diego, CA.
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20
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Needle lost in minimally invasive surgery: management proposal and literature review. J Robot Surg 2018; 12:391-395. [PMID: 29556867 DOI: 10.1007/s11701-018-0802-9] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2017] [Accepted: 03/12/2018] [Indexed: 01/13/2023]
Abstract
The reported incidence of intraoperative retained instruments, such as needles, hangs around 0.06-0.11%. Leaving a needle inside the abdominal cavity can have significant medical and legal consequences. In addition, the retrieval can be hampered due to the limited visualization of the scope during minimally invasive surgery. Factors associated with an increased probability for NL have been described. Prevention for this situation includes: having one needle at a time inside the cavity, effective communication between all personnel in the operating room, evaluation of the strength of the suture-needle connection, avoid parking of needles intraoperatively, and a proper needle withdrawal. Notwithstanding, no agreement has been made regarding NL management. Herein, we present a literature review, and a management proposal in which through a series of systematic steps, the surgical team can efficiently locate and retrieve a lost needle such as: examination of the surgical field, trocar visualization, trocar disassembly, and revision of the suction device. Finally, intraoperative or postoperative imaging can be utilized.
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21
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Nuri T, Ueda K. Minimally invasive technique to remove broken insulin infusion needles: A case report. JOURNAL OF CLINICAL AND TRANSLATIONAL ENDOCRINOLOGY CASE REPORTS 2018. [DOI: 10.1016/j.jecr.2017.12.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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22
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Gopinathan NR, John R, Kanwat H, Sudesh P. Surgical Retrieval of an Impaled Tapestry Needle from the True Pelvic Cavity of a Child-An Unusual Case Report. J Orthop Case Rep 2017; 7:24-28. [PMID: 29242790 PMCID: PMC5727993 DOI: 10.13107/jocr.2250-0685.882] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Introduction: Impalement injuries of pelvis have been reported in children but are uncommon. Impalement could be associated with injuries to deep organs, wound contamination, crush injuries, and in certain instances, can even be fatal. Case Report: We present a bizarre case of a 2-year-old female child who presented to us with a tapestry needle embedded in the true pelvic cavity after a history of fall on the buttock while playing at home. The impaled needle was eventually successfully extracted surgically using the modified Stoppa’s approach and the post-operative period was uneventful. We also briefly review the literature surrounding such unusual injuries and discuss tips and tricks regarding the surgical technique in such cases. Conclusions: In impalement injuries, adequate analgesia, tetanus prophylaxis, antibiotics, and immobilization must be given initially followed by meticulous pre-operative planning in the form of radiographs and computed tomography(CT) scans. Minimally invasive CT-guided extraction of needle can be attempted by an experienced interventional radiologist when there is no significant risk of damaging neighboring vital organs or neurovascular structures. The surgical approach if an open approachis decided must be chosen wisely; backup may be needed from an abdominal surgeon, urologist, or gynecologist in certain cases.
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Affiliation(s)
- Nirmal Raj Gopinathan
- Department of Orthopedics, Post Graduate Institute of Medical Education and Research, Sector 12, Chandigarh, Punjab. India
| | - Rakesh John
- Department of Orthopedics, Post Graduate Institute of Medical Education and Research, Sector 12, Chandigarh, Punjab. India
| | - Himanshu Kanwat
- Department of Orthopedics, Post Graduate Institute of Medical Education and Research, Sector 12, Chandigarh, Punjab. India
| | - Pebam Sudesh
- Department of Orthopedics, Post Graduate Institute of Medical Education and Research, Sector 12, Chandigarh, Punjab. India
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23
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Plager P, Murati MA, Moran A, Sunni M. Two case reports of retained steel insulin pump infusion set needles. Pediatr Diabetes 2016; 17:160-3. [PMID: 25683199 DOI: 10.1111/pedi.12266] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2014] [Revised: 12/29/2014] [Accepted: 01/23/2015] [Indexed: 11/28/2022] Open
Abstract
Insulin pumps are common in the management of type 1 diabetes (T1D). We report two cases of metal insulin infusion set needles which broke off the tubing and remained embedded in the soft tissue of two boys with T1D (five needles in one case, and one needle in the other). The patient with five retained needles was asymptomatic and had a normal physical examination, and the missing needles were only detected using pelvic X-ray; the second patient had only mild discomfort. While these are the first such cases reported in the medical literature, there may be other cases which have gone unnoticed, suggesting the potential need to explore the safety of this product further.
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Affiliation(s)
- Phillip Plager
- Department of Pediatrics, University of Minnesota Masonic Children's Hospital, Minneapolis, MN, 55454, USA
| | - Michael A Murati
- Department of Pediatrics, University of Minnesota Masonic Children's Hospital, Minneapolis, MN, 55454, USA
| | - Antoinette Moran
- Department of Pediatrics, University of Minnesota Masonic Children's Hospital, Minneapolis, MN, 55454, USA
| | - Muna Sunni
- Department of Pediatrics, University of Minnesota Masonic Children's Hospital, Minneapolis, MN, 55454, USA
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