Retained foreign bodies (RFOs) have substantial clinical and financial consequences. In laparoscopic surgery, RFOs can be a cause of needing to convert a minimally invasive surgery (MIS) procedure to an open operation. A coating for surgical models was developed to augment localization of needles using fluorescence appropriate for open and minimally invasive surgeries procedures.
An epoxy matrix containing both dansyl chloride and indocyanine green was coated as visible and near infrared labels, respectively. With ultraviolet excitation, dansyl chloride emits green fluorescence and with NIR excitation, the ICG dye emits radiation observable with specialized near infrared capable laparoscopes. To evaluate the coatings, open and laproscopic surgeries were simulated in rabbits. Surgeons blinded to the type of needles (coated or non-coated) were timed while finding needles in standard conditions and with the use of the adjunct coatings. Control needles not located within 300 seconds were researched with the corresponding near infrared or ultraviolet light. Localization time was evaluated for statistical significance, P < .05.
All dual dye coated needles searched utilizing the near infrared camera (n = 26) or ultraviolet light (n = 26) were located within 300 seconds. Conversely, 9 needles in both control settings (no dye usage) were not located within 300 seconds. Mean time to locate control needles in open surgery and laparoscopic surgery was statistically 2-3× greater than time to localization with the use of dye as an adjunct (P = .0027 open, P < .001 laparoscopic).
Incorporation of a dual-dye fluorescent coating on surgical needles improved the efficiency of locating needles, may minimize the need to convert minimally invasive surgeries procedures to open, and may decrease the consequences of a missed RFO.
To read this article in full you will need to make a payment
Purchase one-time access:Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
One-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:Subscribe to Surgery
Already a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
- Risk factors for retained instruments and sponges after surgery.N Engl J Med. 2003; 348: 229-235
- Retained foreign bodies after surgery.J Surg Res. 2007; 138: 170-174
- A protocol to recover needles lost during minimally invasive surgery.JSLS. 2014; 18 (e2014.00165 [pii])
- Guideline implementation: prevention of retained surgical items.AORN J. 2016; 104: 37-48
- Bar-coding surgical sponges to improve safety: a randomized controlled trial.Ann Surg. 2008; 247: 612-616
- Retained surgical sponges, needles and instruments.Ann R Coll Surg Engl. 2013; 95: 87-92
- Initial clinical evaluation of a handheld device for detecting retained surgical gauze sponges using radiofrequency identification technology.Arch Surg. 2006; 141: 659-662
- Prevention of retained surgical sponges: a decision-analytic model predicting relative cost-effectiveness.Surgery. 2009; 145: 527-535
- Incidence and characteristics of potential and actual retained foreign object events in surgical patients.J Am Coll Surg. 2008; 207: 80-87
- Hook, line, and sinker: hook wire localization of a retained suture needle in the perineum.J Vasc Interv Radiol. 2014; 25: 1479-1480
- Retained dental needle migration across the skull base to the cochlea presenting as hearing loss.Otol Neurotol. 2015; 36: e42-e45
- A retained intraocular surgical needle 2 years after cataract extraction.Arch Ophthalmol. 1999; 117: 691
- Managing the prevention of retained surgical instruments: what is the value of counting?.Ann Surg. 2008; 247: 13-18
- Beyond counting: current evidence on the problem of retaining foreign bodies in surgery?.Ann Surg. 2008; 247: 19-20
- The frequency and significance of discrepancies in the surgical count.Ann Surg. 2008; 248: 337-341
- Efficacy of portable x-ray in identifying retained suture needles in ophthalmologic cases.Eye (Lond). 2009; 23: 1731-1734
- Cost-effectiveness of routine radiographs after emergent open cavity operations.Surgery. 2008; 144: 317-321
- Using a data-matrix-coded sponge counting system across a surgical practice: impact after 18 months.Jt Comm J Qual Patient Saf. 2011; 37: 51-58
- Retained surgical items: a problem yet to be solved.J Am Coll Surg. 2013; 216: 15-22
- Identifying lost surgical needles using radiographic techniques.AORN J. 2003; 78: 73-78
- Management of a broken needle: retained in the first caesarean section, removed during the second abdominal delivery.J Obstet Gynaecol. 2008; 28: 653-655
- Retained surgical needle after laparoscopic sacrocolporectopexy: usefulness of CT fluoroscopy-guided hook-wire placement before surgical removal.Clin Radiol. 2008; 63: 688-690
- Retained surgical items and minimally invasive surgery.World J Surg. 2011; 35: 1532-1539
- Retained needles in laparoscopic surgery: open or observe?.Conn Med. 2014; 78: 197-202
- Intraoperative loss of a surgical needle: a laparoscopic dilemma.JSLS. 2015; 19 (e2013.00401)
- Laparoscopic needle-retrieval device for improving quality of care in minimally invasive surgery.J Am Coll Surg. 2013; 217: 400-405
- Finding a lost needle in laparoscopic surgery.Surg Laparosc Endosc Percutan Tech. 2011; 21: e163-e165
- A prospective study of patient safety in the operating room.Surgery. 2006; 139: 159-173
Published online: January 12, 2018
Accepted: October 4, 2017
Published by Elsevier Inc.