Retained needles in laparoscopic surgery: open or observe?

Currently, there is no standard of care on how to manage a retained needle or foreign body (RFB) during laparoscopic surgery.

A survey presented a relevant case and 18 multiple-choice and open-response questions about personal experience with and attitudes toward RFBs, clinical practices, and management.

From 10/2009-2/2010 we received 255 survey responses. When faced with a patient with a RFB, 45.8% would convert to open, 26.5% would leave needle intraperitoneally, and 27.7% would seek the patient's or family's wishes. When the latter option was eliminated, 54.5% would convert to open, 45.5% would leave the needle intraperitoneally. There were 92.6% who felt that a RFB puts the patient at some degree of future risk, and 89.4% who felt that escalating to laparotomy was of higher risk than the RFB itself.

No current best practice exists regarding approach to RFBs of uncertain injury potential in laparoscopic surgery and similarly in this survey, opinions were split regarding how to proceed.