Retrieving the lost needle during abdominal and pelvic minimally invasive surgeries: a literature review

Losing a surgical instrument during a minimally invasive procedure is uncommon but critical, with an estimated incidence of 0.06% to 0.11%. Needle loss can be challenging even for expert surgeons and increases the operation time considerably. The present study focused on successful retrieval techniques for lost needles during laparoscopic and robot-assisted abdominal and pelvic surgeries by reviewing the reported cases in the literature. We aimed to identify information, such as time for needle loss, successful and failed attempts for needle-retrieval, imaging modalities to identify the lost needle, and using special instruments or techniques. The needle withdrawing from the surgical port is the most commonly reported time for needle loss; however, needle loss can occur during needle introduction and suturing. After losing a needle, the camera's first attempt at intra-operative exploration of the surgical field is usually unsuccessful. Nevertheless, the intra-operative X-ray is the most commonly used modality in locating the lost needle successfully. Data suggests that surgical instruments, including ports, are considerable locations for finding the lost needle, which makes port disassembly and visualization one of the principal aspects of needle-retrieval. Some studies report specific instruments for needle-retrieval, including magnets, micro-laparoscopes, semi-rigid hysteroscopes, and needle holders, which may be helpful in exceptional cases. Future studies should compare different methods for needle-retrieval in a considerable population.