Medina Luis G, Martin Oscar, Cacciamani Giovannni E, Ahmadi Nariman, Castro Juan C, Sotelo Rene
Catherine and Joseph Aresty Department of Urology, USC Institute of Urology, Keck School of Medicine, University of Southern California, 1441 Eastlake Avenue, Suite 7416, Los Angeles, CA, 90089-2211, USA.
Facultad de Medicina, Clínica Cooperativa de Colombia, Universidad Cooperativa de Colombia, Villavicencio, Colombia.
J Robot Surg. 2018 Sep;12(3):391-395. doi: 10.1007/s11701-018-0802-9. Epub 2018 Mar 19.
The reported incidence of intraoperative retained instruments, such as needles, hangs around 0.06-0.11%. Leaving a needle inside the abdominal cavity can have significant medical and legal consequences. In addition, the retrieval can be hampered due to the limited visualization of the scope during minimally invasive surgery. Factors associated with an increased probability for NL have been described. Prevention for this situation includes: having one needle at a time inside the cavity, effective communication between all personnel in the operating room, evaluation of the strength of the suture-needle connection, avoid parking of needles intraoperatively, and a proper needle withdrawal. Notwithstanding, no agreement has been made regarding NL management. Herein, we present a literature review, and a management proposal in which through a series of systematic steps, the surgical team can efficiently locate and retrieve a lost needle such as: examination of the surgical field, trocar visualization, trocar disassembly, and revision of the suction device. Finally, intraoperative or postoperative imaging can be utilized.
据报道，术中遗留器械（如针）的发生率约为0.06%-0.11%。将针遗留在腹腔内会产生重大的医疗和法律后果。此外，在微创手术中，由于视野有限，针的取出可能会受到阻碍。已经描述了与针遗留概率增加相关的因素。针对这种情况的预防措施包括：一次只在腔内放置一根针、手术室所有人员之间进行有效的沟通、评估缝合针连接的牢固程度、避免术中针的搁置以及正确取出针。尽管如此，关于针遗留的处理尚未达成共识。在此，我们进行文献综述并提出一种处理建议，通过一系列系统步骤，手术团队可以有效地定位并取出丢失的针，例如：检查手术区域、观察套管针、拆卸套管针以及检查吸引装置。最后，可以利用术中或术后成像。
