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Chhetry M, Yadav J, Baniya A. Long forgotten perfume bottle nozzle in the uterus: challenges in retrieval in a low resource setting! J Surg Case Rep 2025; 2025:rjaf053. [PMID: 39975843 PMCID: PMC11836534 DOI: 10.1093/jscr/rjaf053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2024] [Accepted: 01/27/2025] [Indexed: 02/21/2025] Open
Abstract
Foreign body in the uterus may lead to severe complications and pose significant management dilemmas. We report a 26-year-old lady who presented with foul-smelling discharge, subfertility, and a failed attempt at foreign body removal outside. Pelvic ultrasound revealed an impacted structure in the endocervical canal while a descending pipe was visualized in the endocervical canal per speculum examination. Partial removal vaginally and surgical removal of the nozzle via laparotomy was necessary due to the size, location, and impaction of the object. Posterior uterine incision was used due to easy accessibility. The post-operative stay was uneventful. This case underscores the importance of early detection, imaging, and multidisciplinary management in cases of uterine foreign bodies.
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Affiliation(s)
- Manisha Chhetry
- Department of Obstetrics and Gynecology, BPKIHS, Dharan, 56700, Nepal
| | - Jyotsna Yadav
- Department of Obstetrics and Gynecology, BPKIHS, Dharan, 56700, Nepal
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2
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Eibschutz L, Lu MY, Abbassi MT, Gholamrezanezhad A. Artificial intelligence in the detection of non-biological materials. Emerg Radiol 2024; 31:391-403. [PMID: 38530436 PMCID: PMC11130001 DOI: 10.1007/s10140-024-02222-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2024] [Accepted: 03/14/2024] [Indexed: 03/28/2024]
Abstract
Artificial Intelligence (AI) has emerged as a transformative force within medical imaging, making significant strides within emergency radiology. Presently, there is a strong reliance on radiologists to accurately diagnose and characterize foreign bodies in a timely fashion, a task that can be readily augmented with AI tools. This article will first explore the most common clinical scenarios involving foreign bodies, such as retained surgical instruments, open and penetrating injuries, catheter and tube malposition, and foreign body ingestion and aspiration. By initially exploring the existing imaging techniques employed for diagnosing these conditions, the potential role of AI in detecting non-biological materials can be better elucidated. Yet, the heterogeneous nature of foreign bodies and limited data availability complicates the development of computer-aided detection models. Despite these challenges, integrating AI can potentially decrease radiologist workload, enhance diagnostic accuracy, and improve patient outcomes.
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Affiliation(s)
- Liesl Eibschutz
- Department of Radiology Division of Emergency Radiology, Keck School of Medicine, University of Southern California (USC), 1500 San Pablo Street, Los Angeles, CA, 90033, USA
| | - Max Yang Lu
- Department of Radiology Division of Emergency Radiology, Keck School of Medicine, University of Southern California (USC), 1500 San Pablo Street, Los Angeles, CA, 90033, USA
| | - Mashya T Abbassi
- Department of Radiology Division of Emergency Radiology, Keck School of Medicine, University of Southern California (USC), 1500 San Pablo Street, Los Angeles, CA, 90033, USA
| | - Ali Gholamrezanezhad
- Department of Radiology Division of Emergency Radiology, Keck School of Medicine, University of Southern California (USC), 1500 San Pablo Street, Los Angeles, CA, 90033, USA.
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3
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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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4
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Arora JS, Kim JK, Pakvasa M, Sayadi LR, Lem M, Widgerow AD, Leis AR. Microsurgical Needle Retention Does Not Cause Pain or Neurovascular Injury in a Rat Model. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2023; 11:e5171. [PMID: 37547344 PMCID: PMC10402969 DOI: 10.1097/gox.0000000000005171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Accepted: 06/20/2023] [Indexed: 08/08/2023]
Abstract
Approximately 20% of retained foreign bodies are surgical needles. Retained macro-needles may become symptomatic, but the effect of microsurgical needles is uncertain. We present the first animal model to simulate microsurgical needle retention. Given a lack of reported adverse outcomes associated with macro-needles and a smaller cutting area of microsurgical needles, we hypothesized that microsurgical needles in rats would not cause changes in health or neurovascular compromise. Methods Male Sprague-Dawley rats (x̄ weight: 288.9 g) were implanted with a single, 9.0 needle (n = 8) or 8.0 needle (n = 8) orthogonal to the right femoral vessels and sutured in place. A control group (n = 8) underwent sham surgery. Weekly, a cumulative health score evaluating body weight, body condition score, physical appearance, and behavior for each rat was determined. Infrared thermography (°C, FLIR one) of each hindlimb and the difference was obtained on postoperative days 15, 30, 60, and 90. On day 90, animals were euthanatized, hindlimbs were imaged via fluoroscopy, and needles were explanted. Results The mean, cumulative health score for all cohorts at each weekly timepoint was 0. The mean temperature difference was not significantly different on postoperative days 15 (P = 0.54), 30 (P = 0.97), 60 (P = 0.29), or 90 (P = 0.09). In seven of eight rats, 8.0 needles were recovered and visualized on fluoroscopy. In six of eight rats, 9.0 needles were recovered, but 0/8 needles were visualized on fluoroscopy. Conclusions Microsurgical needle retention near neurovascular structures may be benign, and imaging for needles smaller than 8.0 may be futile. Further studies should explore microsurgical needle retention potentially through larger animal models.
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Affiliation(s)
- Jagmeet S. Arora
- From the School of Medicine, University of California Irvine, Orange, Calif
| | | | - Mikhail Pakvasa
- Department of Plastic Surgery, University of California Irvine, Orange, Calif
| | - Lohrasb R. Sayadi
- Department of Plastic Surgery, University of California Irvine, Orange, Calif
| | - Melinda Lem
- From the School of Medicine, University of California Irvine, Orange, Calif
| | - Alan D. Widgerow
- Center for Tissue Engineering, Department of Plastic Surgery, University of California Irvine, Orange, Calif
| | - Amber R. Leis
- Department of Plastic Surgery, University of California Irvine, Orange, Calif
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5
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Koida Y, Kiuchi H, Yoshioka F, Soda T, Sekii K. Lost Needle During Robot-Assisted Radical Prostatectomy: A Case Report and Literature Review. Cureus 2023; 15:e42119. [PMID: 37602099 PMCID: PMC10436752 DOI: 10.7759/cureus.42119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/19/2023] [Indexed: 08/22/2023] Open
Abstract
Laparoscopic or robotic radical prostatectomy and partial nephrectomy require needle suturing and manipulation. Although uncommon, if a needle is lost during laparoscopy, locating and removing it is challenging. Here, we report a case of needle loss during robot-assisted laparoscopic radical prostatectomy (RARP). A 51-year-old patient with localized prostate cancer underwent RARP. After vesicourethral anastomosis using a 3-0 Barbed Suture with two threads connected in the tail, the two threads were held with a needle holder. One needle was lost during removal through a 12 mm trocar. A thorough laparoscopic examination of the abdominal cavity identified a needle attached to the abdominal wall, which was successfully removed. Needle loss is uncommon, but familiarity with handling and preventing such cases helps surgeons address further deterioration. Stepwise and intensive exploration should be performed to confirm the needle location.
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6
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Huang J, Guo M, zhang W, Li C. A straw entering the abdominal cavity through the female reproductive tract: a case report. J Int Med Res 2022; 50:3000605221142403. [PMID: 36482662 PMCID: PMC9743020 DOI: 10.1177/03000605221142403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
In this article, an unusual case of a 27-year-old woman, who presented with abdominal pain for the previous 2 days, is presented. Ultrasonography revealed a perforated uterus and a straw in the abdominal cavity. A foreign body in the abdominal cavity was diagnosed and removed by laparoscopic surgery, and antibiotics were administered. The patient reported no discomfort during follow-up for 1 month. This report highlights the rare case of a foreign body crossing the uterus into the abdominal cavity. The only possible action was immediate surgery to remove the foreign body from the abdominal cavity.
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Affiliation(s)
- Jincheng Huang
- Jincheng Huang, SSL Central Hospital of Dongguan City, 1 Xianglong Road, Huangzhou District, Shilong Town, Dongguan, Guangdong Province 523000, China.
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7
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Wen TC, Lin KH, Chen YY. Migration of a Retained Surgical Suture Needle in the Common Bile Duct. Diagnostics (Basel) 2022; 12:diagnostics12102276. [PMID: 36291966 PMCID: PMC9599985 DOI: 10.3390/diagnostics12102276] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Revised: 09/13/2022] [Accepted: 09/18/2022] [Indexed: 11/16/2022] Open
Abstract
Retained surgical foreign bodies have been a cause of concern since physicians began operating on patients. Retained surgical foreign bodies in the common bile duct (CBD) are rare and may cause cholangitis and jaundice. We report the case of a patient who initially presented with fever and right upper-quadrant abdominal pain. He had received cholecystectomy and choledochojejunostomy 28 years ago and had been well since then. Abdominal computed tomography (CT) revealed left-lobe liver abscess and a linear curve of high-density material. Endoscopic retrograde cholangiopancreatography (ERCP) displayed mild dilatation of the common bile duct (CBD) and choledojejunostomic fistula of the middle CBD. A curved, linear, rusty, metallic surgical suture needle was detected and successfully removed under ERCP.
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Affiliation(s)
- Tzu-Cheng Wen
- Department of Gastroenterology, Endoscopy Center, Changhua Christian Hospital, Changhua 500, Taiwan
| | - Kuo-Hua Lin
- Department of Gastroenterology, Endoscopy Center, Changhua Christian Hospital, Changhua 500, Taiwan
| | - Yang-Yuan Chen
- Department of Gastroenterology, Changhua Christian Hospital, Changhua 500, Taiwan
- Correspondence: ; Tel.: +886-4-7359253
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8
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Cahn J. Clinical Issues-March 2022. AORN J 2022; 115:273-281. [PMID: 35213043 DOI: 10.1002/aorn.13631] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Accepted: 11/03/2021] [Indexed: 11/09/2022]
Abstract
Nursing scope of practice Key words: state nurse practice act (NPA), state board of nursing, decision-making framework, standards, guidance. Practice of unlicensed perioperative personnel Key words: job description, task delegation, unlicensed personnel, allied health care provider, scope of practice. Definition of a cavity for counting procedures Key words: anatomical hollow space, counting, cavity, retained surgical item (RSI), retained foreign object (RFO). Identifying retained suture needles on radiographic images Key words: suture needle size, suture needle length, radiographic imaging, counting procedures, count discrepancy.
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9
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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: 0.6] [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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10
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Raut AA, Naphade PS, Maheshwari S. Abdominal Radiograph. JOURNAL OF GASTROINTESTINAL AND ABDOMINAL RADIOLOGY 2020. [DOI: 10.1055/s-0040-1701327] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
Abstract
AbstractAbdominal radiograph (AR) is often the initial radiological investigation performed while investigating abdominal pain even today. However, in the era of cross-sectional imaging, the role of AR in the diagnosis of acute pain abdomen is being questioned. When AR is used as a screening modality, the diagnostic yield is low. When performed in suspected cases of bowel obstruction or perforation, urinary calculi, or bowel ischemia, AR is often helpful. AR is often the first radiological investigation performed in acute abdomen. Although the role of plain radiograph is limited in the era of cross-sectional imaging, systemic approach and vigilant search for the radiological features on AR may be diagnostic and decide further line of investigation. Various gas patterns of intraluminal and free peritoneal air are helpful in localizing pathology. Different patterns of calcification seen in abdomen, ingested or inserted foreign bodies, and location of medical devices give a clue to diagnosis.
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Affiliation(s)
- Abhijit A. Raut
- Department of Radiology, Kokilaben Dhirubhai Ambani Hospital, Mumbai, Maharashtra, India
| | | | - Sharad Maheshwari
- Department of Radiology, Kokilaben Dhirubhai Ambani Hospital, Mumbai, Maharashtra, India
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11
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Steelman VM, Shaw C, Shine L, Hardy-Fairbanks AJ. Unintentionally Retained Foreign Objects: A Descriptive Study of 308 Sentinel Events and Contributing Factors. Jt Comm J Qual Patient Saf 2018; 45:249-258. [PMID: 30341013 DOI: 10.1016/j.jcjq.2018.09.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2018] [Revised: 09/04/2018] [Accepted: 09/04/2018] [Indexed: 10/28/2022]
Abstract
OBJECTIVE Unintentionally retained foreign objects (URFOs) remain the sentinel events most frequently reported to The Joint Commission. The objective of this study was to describe reports of URFOs, including the types of objects, anatomic locations, contributing factors, and harm, in order to make recommendations to improve perioperative safety. METHODS A retrospective review was undertaken of events involving URFOs reported to The Joint Commission from October 2012 through March 2018. Inclusion criteria were events meeting Joint Commission definitions of URFO and sentinel event. Exclusion criteria were sponges used intraoperatively and guidewires. Event reports included patients undergoing surgery, child birth, wound care, and other invasive procedures. RESULTS A total of 308 events involving URFOs were reported: instruments (102), catheters and drains (52), needles and blades (33), packing (30), implants (14), specimens (6), and other items (71). Many of the instruments were used in minimally invasive or orthopedic surgery. Items were most frequently retained in the abdomen or the vagina. Most URFOs occurred in the operating room. A total of 1,156 contributing factors were identified, most frequently in the categories human factors, leadership, and communication. In the majority of reports, the harm was categorized as unexpected additional care/extended stay. Five patients died as a result of the URFO. CONCLUSION We describe events involving URFOs voluntarily reported to The Joint Commission. The variety of retained items, the departments involved, and the large number of contributing factors demonstrate the complexity of patient care and the need for a multifaceted plan for prevention. We make recommendations based on these findings.
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Affiliation(s)
| | - Clarissa Shaw
- is PhD Student, College of Nursing, University of Iowa
| | - Laurel Shine
- is Patient Safety Specialist, Office of Quality and Patient Safety, The Joint Commission, Oakbrook Terrace, Illinois
| | - Abbey J Hardy-Fairbanks
- is Clinical Associate Professor, Department of General Obstetrics and Gynecology, and Director, Women's Health Clinic Procedure Clinic, University of Iowa Hospitals & Clinics, University of Iowa
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12
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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: 2.3] [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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13
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Intraoperative radiography for evaluation of surgical miscounts. J Am Coll Radiol 2015; 12:824-9. [PMID: 26044645 DOI: 10.1016/j.jacr.2015.03.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2015] [Accepted: 03/02/2015] [Indexed: 11/24/2022]
Abstract
PURPOSE Retained surgical items result in substantial morbidity, health care-related expense, and legal liability. This study determines the performance of a protocol for locating surgical items after a miscount, in which intraoperative radiography included a radiograph of the unaccounted for item. METHODS Institutional review board approval was obtained. In 20,820 operations performed between January 1, 2011 and April 1, 2013, a total of 183 consecutive surgical miscounts occurred, involving 180 patients (97 male, 83 female; median age: 55 years). Departmental protocol mandated that a radiograph of an example of the potentially retained item be taken simultaneously with each patient intraoperative radiograph. Three board-certified radiologists retrospectively reviewed these radiographs and follow-up imaging, achieving consensus on interpretation. Adherence to institutional protocol was assessed. Demographic data, surgical documentation, and clinical follow-up data were recorded. RESULTS The incidence of surgical miscounts was 0.9% (183 of 20,820). Only 9% (17 of 183) were resolved by discovery: outside the patient (8 cases); on intraoperative radiographs (5 cases); incidentally on follow-up radiographs (2 cases); and on retrospective review (2 cases). The false-negative rate was 44% (4 of 9). Neither of the 2 retained needles discovered postoperatively was removed. The procedures most prone to miscounts were: esophagogastrectomy (33%; 2 of 6); liver transplant (18%; 12 of 66); and Whipple procedure (16%; 7 of 44). Needles (65%) and sponges (9%) were the items that were overlooked most often. Adherence to the protocol of imaging an example of a potentially retained item was 91% (167 of 183). CONCLUSIONS Despite good adherence to a protocol of imaging the potentially retained items, small needles often were not visualized on intraoperative radiographs and were not subsequently removed, without known adverse events. This finding suggests that intraoperative radiography for small needles may be unnecessary, but further study is required.
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14
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Porter KK, Woods RW, Bailey PD, Scott WW, Johnson PT. Positive control radiographs for identifying a suspected retained surgical item. J Am Coll Radiol 2015; 12:830-2. [PMID: 26014923 DOI: 10.1016/j.jacr.2015.03.043] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2015] [Accepted: 03/27/2015] [Indexed: 10/23/2022]
Affiliation(s)
- Kristin Kelly Porter
- Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins Medical Institutions, Baltimore, Maryland.
| | - Ryan W Woods
- Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins Medical Institutions, Baltimore, Maryland
| | - Paul D Bailey
- Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins Medical Institutions, Baltimore, Maryland
| | - William W Scott
- Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins Medical Institutions, Baltimore, Maryland
| | - Pamela T Johnson
- Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins Medical Institutions, Baltimore, Maryland
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15
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Radiographic Detectability of Retained Neuropatties in a Cadaver Model. World Neurosurg 2015; 84:405-11. [PMID: 25818890 DOI: 10.1016/j.wneu.2015.03.032] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2015] [Revised: 03/20/2015] [Accepted: 03/21/2015] [Indexed: 11/20/2022]
Abstract
BACKGROUND Counts are the commonest method used to ensure that all sponges and neuropatties are removed from a surgical site before closure. When the count is not reconciled, plain radiographs of the operative site are taken to determine whether the missing patty has been left in the wound. The purpose of this study was to describe the detectability of commonly used neuropatties in the clinical setting using digital technologies. METHODS Neuropatties were implanted into the anterior and posterior cranial fossae and the thoracolumbar extradural space of a mature male cadaver. Four neuropatty sizes were used: 3 × 1 in, 2 × ½ in, ½ × ½ in, and ¼ × ¼ in. Neuropatties, with size and location chosen at random, were placed in the surgical sites and anteroposterior/posterior-anterior and lateral radiographs were taken using standard portable digital radiographic equipment. Six clinicians reviewed the digital images for the presence or absence of neuropatties. The readers were not aware of the number and size of the patties that were included in each image. RESULTS The detectability of neuropatties is dependent on the size of the neuropatty's radiopaque marker and the operative site. Neuropatties measuring 2 × ½ in and 3 × 1 in were detected reliably regardless of the operative site. ¼ × ¼ in neuropatties were poorly detected by neurosurgeons and radiologists in all three operative sites. Readers of various experience and background were similar in their ability to detect neuropatties under these conditions. CONCLUSIONS Under simulated operating room conditions and using currently available neuropatties and plain radiograph imaging technology, small ¼-in and ½-in neuropatties are poorly visible/detectable on digital images.
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16
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Judson TJ, Howell MD, Guglielmi C, Canacari E, Sands K. Miscount incidents: a novel approach to exploring risk factors for unintentionally retained surgical items. Jt Comm J Qual Patient Saf 2013; 39:468-74. [PMID: 24195200 DOI: 10.1016/s1553-7250(13)39060-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND An estimated 1,500 operations result in retained surgical items (RSIs) each year in the United States, resulting in substantial morbidity. The rarity of these events makes studying them difficult, but miscount incidents may provide a window into understanding risk factors for RSIs. METHODS A cohort study of all consecutive operative cases during a 12-month period was conducted at a large academic medical center to identify risk factors for surgical miscounts. A multidisciplinary electronic miscount reconciliation checklist (necessitating both surgeon and nurse input) was introduced into the internally developed electronic Perioperative Information Management System to build a predictive model for RSI cases. RESULTS Among 23,955 operations, 84 resulted in miscount incidents (0.35% [95% confidence interval: 0.28% to 0.43%]). Increased case duration was strongly associated with increased risk of a miscount in unadjusted analyses (p < .0001). In the nested case-control analysis, both the case duration and the number of providers present were independently associated with a more than doubling of the odds of a miscount, even after adjustment for one another, the elective/urgent/emergent status of a case, and personnel changes occurring during the case. CONCLUSIONS The finding that both the length of the case and the number of providers involved in the case were independent risk factors for miscount incidents may offer insight into risk-targeted strategies to prevent RSIs, such as postoperative imaging, bar-coded surgical items, and radiofrequency technology. Miscounts trigger use of the Incorrect Count Safety Checklist, which can be used to determine whether a count completed at the procedure's conclusion is consistent across disciplines (circulating nurses, scrub persons, surgeons).
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17
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Cole KM, Viscofsky NA, Ebrahimi M. Finding a Needle in the Dark. AORN J 2013; 98:532-7. [DOI: 10.1016/j.aorn.2013.08.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2013] [Revised: 06/03/2013] [Accepted: 08/15/2013] [Indexed: 10/26/2022]
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18
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Halverson M, Servaes S. Foreign bodies: radiopaque compared to what? Pediatr Radiol 2013; 43:1103-7. [PMID: 23576014 DOI: 10.1007/s00247-013-2660-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2012] [Revised: 01/08/2013] [Accepted: 01/30/2013] [Indexed: 11/26/2022]
Abstract
BACKGROUND The term "radiopaque" is commonly used when discussing foreign bodies and lists of radiopaque and non-radiopaque materials are sometimes created, but radiopacity is not a binary concept. A more fundamental understanding of radiopacity is necessary for the work-up of foreign bodies. OBJECTIVE To demonstrate that "radiopaque" is a relative term. MATERIALS AND METHODS Twenty foreign bodies of various sizes, shapes and materials were placed in a basin. Radiographs were obtained of the objects with 0, 2.5, 5 and 10 cm depth of water in the basin to simulate the appearance of a foreign body in human tissue. The progressively changing appearance of the objects was observed. RESULTS All of the objects were radiographically visible in the empty basin. Different objects demonstrated different appearances when immersed in progressively deeper levels of water, illustrating the effect of the surrounding water as well as the effects of object shape, size, orientation and composition. CONCLUSION The concept of radiopacity seems simple and the term "radiopaque" is sometimes used to describe an all or none phenomenon. However, radiopacity is a comparative concept implying relative X-ray attenuation. Accurate understanding of the radiographic appearance of foreign bodies requires one to keep in mind the concepts of relative X-ray attenuation and contrast resolution.
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Affiliation(s)
- Mark Halverson
- Department of Radiology, The Children's Hospital of Philadelphia, Philadelphia, PA 19104, USA.
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Laparoscopic needle-retrieval device for improving quality of care in minimally invasive surgery. J Am Coll Surg 2013; 217:400-5. [PMID: 23707045 DOI: 10.1016/j.jamcollsurg.2013.02.035] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2013] [Revised: 02/25/2013] [Accepted: 02/26/2013] [Indexed: 11/22/2022]
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. STUDY DESIGN 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.
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Mahran MA, Toeima E, Morris EP. The recurring problem of retained swabs and instruments. Best Pract Res Clin Obstet Gynaecol 2013; 27:489-95. [PMID: 23578840 DOI: 10.1016/j.bpobgyn.2013.03.001] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2012] [Accepted: 03/01/2013] [Indexed: 10/27/2022]
Abstract
Patient safety is one of the most pressing challenges in health care. The promotion of safety requires that all those involved in healthcare realise that the potential for errors exists, and that teamwork and communication are essential for preventing errors. Incidents compromising patient safety, such as unintended retention of swabs or instruments, are regarded as 'never events'. These incidents are considered 'unacceptable and eminently preventable', as pointed out by the Department of Health 'never events list' 2012/2013. One estimate says that one case of a retained item occurs at least once a year in a major hospital where 8000 to 18,000 major cases are carried out each year. All healthcare organisations should take appropriate measures to prevent retention of foreign bodies by consistent application of reliable and standardised processes of care. In this review, we explore the risks and complications associated with retained swabs and instruments, and different ways to prevent such risks to patients.
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Affiliation(s)
- Montasser A Mahran
- Norfolk and Norwich University Hospital NHS Foundation Trust, Colney Lane, Norwich, Norfolk NR4 7UY, UK
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Is there an advantage of three dimensional computed tomography scanning over plain abdominal radiograph in the detection of retained needles in the abdomen? Int J Surg 2013; 11:278-81. [PMID: 23376172 DOI: 10.1016/j.ijsu.2013.01.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2013] [Accepted: 01/17/2013] [Indexed: 11/21/2022]
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Goldberg JL, Feldman DL. Implementing AORN recommended practices for prevention of retained surgical items. AORN J 2012; 95:205-16; quiz 217-9. [PMID: 22283912 DOI: 10.1016/j.aorn.2011.11.010] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2011] [Revised: 09/04/2011] [Accepted: 11/11/2011] [Indexed: 11/15/2022]
Abstract
Retention of a surgical item is a preventable event that can result in patient injury. AORN's "Recommended practices for prevention of retained surgical items" emphasizes the importance of using a multidisciplinary approach for prevention. Procedures should include counts of soft goods, needles, miscellaneous items, and instruments, and efforts should be made to prevent retention of fragments of broken devices. If a count discrepancy occurs, the perioperative team should follow procedures to locate the missing item. Perioperative leaders may consider the use of adjunct technologies such as bar-code scanning, radio-frequency detection, and radio-frequency identification. Ambulatory and hospital patient scenarios are included to exemplify appropriate strategies for preventing retained surgical items.
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Abstract
Reduction in retained surgical items is an important part of any operating room patient-safety effort. Any item used in an operation can result in a retained surgical item, but sponges are the most frequent and the abdomen is the most common location. Retained sponges can cause significant morbidity, and the costs associated with both prevention and treatment of retained surgical items, including legal costs, can be considerable. This review will examine counting, teamwork, radiography, and new technology as methods used to prevent retained surgical items. Even though none of these techniques individually is likely to completely prevent retained surgical items, when used together the numbers can be reduced.
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Asiyanbola B, Cheng-Wu C, Lewin JS, Etienne-Cummings R. Modified map-seeking circuit: use of computer-aided detection in locating postoperative retained foreign bodies. J Surg Res 2011; 175:e47-52. [PMID: 22440933 DOI: 10.1016/j.jss.2011.11.1018] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2011] [Revised: 10/07/2011] [Accepted: 11/18/2011] [Indexed: 11/26/2022]
Abstract
BACKGROUND More than 98% of intra-operative X-rays taken to search for postoperative retained foreign bodies (RFBs) have negative findings; in over 30% of cases of such X-rays, the finding is a false negative. Newer technologies created to find RFBs must not only reduce the false-negative rate, but also must not increase the burden of detecting RFBs. We have introduced the use of computer-aided detection (CAD) to facilitate the detection of RFBs on X-rays utilizing a modified version of map-seeking circuit (MSC) algorithm the referenced map-seeking circuit (RMSC), for our proof-of-concept study for detection of needles in plain abdominal X-rays. METHODS Images were obtained by using a portable cassette-based X-ray machine and a C-arm (digital) machine, both of which are commonly used in the operating room. The images obtained using these machines were divided into subimages of approximately 250 × 250 pixels each, for a total of 455 subimages from the cassette-based machine (A) and 365 from the digital machine (B) for use as test samples. Images obtained from A and B were analyzed separately using our modified MSC algorithm with a minimum (τ = 0) and a maximum threshold (τ = 0.5). RESULTS The automated detection rate (positive predictive value) was 86%, with a false positive/negative rate of 10% to 15% when τ was zero. CONCLUSION The CAD-based RMSC algorithm has the potential to improve the accuracy with which RFBs can be found in X-rays. Further research is needed to optimize the detection rate and to identify a wider range of RFBs.
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Affiliation(s)
- Bolanle Asiyanbola
- Department of Surgery, School of Medicine, Johns Hopkins Medical Institute, Baltimore, Maryland 21224, USA.
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Abstract
Research from the United States which explores events related to the surgical count has identified that there are opportunities to review our practice in order to reduce risks to surgical patients. The Safe Surgery Saves Lives Campaign highlights this aspect of perioperative patient safety, ensuring that poor processes and poor communication, often the reasons for retained surgical items, become part of the team 'sign-out' at the end of every operation.
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Regenbogen SE, Greenberg CC, Resch SC, Kollengode A, Cima RR, Zinner MJ, Gawande AA. Prevention of retained surgical sponges: a decision-analytic model predicting relative cost-effectiveness. Surgery 2009; 145:527-35. [PMID: 19375612 PMCID: PMC2725304 DOI: 10.1016/j.surg.2009.01.011] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2008] [Accepted: 01/28/2009] [Indexed: 10/21/2022]
Abstract
BACKGROUND New technologies are available to reduce or prevent retained surgical sponges (RSS), but their relative cost effectiveness are unknown. We developed an empirically calibrated decision-analytic model comparing standard counting against alternative strategies: universal or selective x-ray, bar-coded sponges (BCS), and radiofrequency-tagged (RF) sponges. METHODS Key model parameters were obtained from field observations during a randomized-controlled BCS trial (n = 298), an observational study of RSS (n = 191,168), and clinical experience with BCS (n approximately 60,000). Because no comparable data exist for RF, we modeled its performance under 2 alternative assumptions. Only incremental sponge-tracking costs, excluding those common to all strategies, were considered. Main outcomes were RSS incidence and cost-effectiveness ratios for each strategy, from the institutional decision maker's perspective. RESULTS Standard counting detects 82% of RSS. Bar coding prevents > or =97.5% for an additional $95,000 per RSS averted. If RF were as effective as bar coding, it would cost $720,000 per additional RSS averted (versus standard counting). Universal and selective x-rays for high-risk operations are more costly, but less effective than BCS-$1.1 to 1.4 million per RSS event prevented. In sensitivity analyses, results were robust over the plausible range of effectiveness assumptions, but sensitive to cost. CONCLUSION Using currently available data, this analysis provides a useful model for comparing the relative cost effectiveness of existing sponge-tracking strategies. Selecting the best method for an institution depends on its priorities: ease of use, cost reduction, or ensuring RSS are truly "never events." Given medical and liability costs of >$200,000 per incident, novel technologies can substantially reduce the incidence of RSS at an acceptable cost.
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Affiliation(s)
- Scott E Regenbogen
- Department of Health Policy and Management, Harvard School of Public Health, Boston, MA, USA.
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Affiliation(s)
- Caprice C Greenberg
- Department of Surgery, Center for Surgery and Public Health, Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02115, USA
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