Exploring the Causes of Suture Needle Loss Through Simulation and Finite Element Analysis

The intraoperative loss of suture needles can prolong procedures and compromise safety, often occurring when a needle holder is unintentionally dropped and opens. This study explored the mechanism of needle loss through a nationwide survey, controlled drop simulations, and finite element analysis. Among 3649 OR nurses surveyed, 75.4% identified instrument transfer-specifically dropping the needle holder onto the instrument table-as the most common cause of loss. In 1500 simulated drops, unexpected opening occurred in 30.6% of cases, primarily when the holder landed flat or on its ring. Finite element analysis revealed that impact-induced clamp ring deformation displaces locking teeth beyond their biting depth, triggering release. Larger, heavier holders increased both opening risk and needle flight velocity. Design modifications, such as reinforcing the clamp ring and deepening locking teeth, along with cushioned surfaces, may reduce loss events and improve perioperative safety.