Detection rates of missing microsurgical needles using intra-operative imaging

Area of Science:

• Medical Imaging
• Surgical Safety
• Medical Device Technology

Background:

• Unintentional retention of foreign bodies during surgery, though uncommon, poses significant risks.
• Data on the consequences of retained surgical needles is limited.
• This study addresses the characterization and detection of lost surgical needles.

Purpose of the Study:

• To characterize lost surgical needles encountered at an institution.
• To evaluate the reliability of detecting retained microsurgical needles using fluoroscopy.

Main Methods:

• A review of reported missing surgical needles was conducted.
• Surgical needles of various sizes were placed on an anthropomorphic model in anatomical locations.
• Fluoroscopic images were captured at different resolutions, and medical staff attempted needle detection.

Main Results:

• Over a 2.5-year period, 62 needles were reported missing out of 46,323 procedures, with no documented patient harm.
• Needles with a chord length of 16mm or greater were always detected.
• High-resolution fluoroscopy improved detection of needles down to 6.6mm, with better detection in the lower limb for needles >6.6mm.

Conclusions:

• Needles >13mm are reliably detected; 3.8mm needles are not.
• Detection of intermediate-sized needles is enhanced by high-resolution fluoroscopy, lower limb imaging, and senior observers.
• Fluoroscopic detection of microsurgical needles may not be necessary or cost-effective.