McCombe Alistair, Heald Alicia, Wagels Michael
Department of Plastic & Reconstructive Surgery, Princess Alexandra Hospital, Brisbane, Queensland, Australia.
School of Medicine, University of Queensland, Brisbane, Queensland, Australia.
ANZ J Surg. 2021 Mar;91(3):420-424. doi: 10.1111/ans.16302. Epub 2020 Sep 11.
Unintentional retention of foreign bodies in surgery is uncommon but potentially serious. Published data regarding the consequence of retained surgical needles is sparse. We aimed to characterize lost surgical needles at our institution. Secondarily, we aimed to determine whether or not retained microsurgical needles can be reliably detected.
Reports of missing surgical needles at our institution were reviewed. Surgical needles of relevant sizes were scattered across an anthropomorphic model at representative anatomical locations. Fluoroscopic images of the field were acquired using two resolution settings. Medical staff in our department attempted to locate needles in these images.
A total of 46 323 procedures were performed in the main theatres in the 2.5-year period. Sixty-two needles were reported as missing. No patient harm was documented. Needles of chord length 16 mm (5-0) or greater were always detected. High-resolution fluoroscopy improves detection of needles with chord lengths of 9.3 (7-0) or 6.6 mm (9-0). Needles are consistently better detected in the lower limb for needles of chord length greater than 6.6 mm (9-0). Senior observers under ideal conditions can detect 7.1% of smaller needles.
When a needle is lost during surgery, consider the following before ordering fluoroscopy. Needles of chord length greater than 13 mm (6-0) should be reliably detected whilst 3.8 mm (10-0) needles will not. For sizes in between, ideal conditions for detection may include an operating field in the lower limb, high-resolution fluoroscopy and a senior observer. It may not be necessary or cost effective to identify microsurgical needles with fluoroscopy.
手术中意外遗留异物并不常见，但可能后果严重。关于遗留手术针后果的已发表数据稀少。我们旨在描述我院丢失手术针的情况。其次，我们旨在确定是否能可靠检测出遗留的显微手术针。
回顾我院手术针丢失报告。将相关尺寸的手术针散布在拟人模型的代表性解剖位置。使用两种分辨率设置获取该区域的荧光透视图像。我院科室的医务人员试图在这些图像中找到针。
在2.5年期间，主手术室共进行了46323例手术。报告有62根针丢失。未记录有患者受到伤害。弦长16毫米（5-0）或更长的针总能被检测到。高分辨率荧光透视可提高对弦长9.3毫米（（7-0）或6.6毫米（9-0）针的检测率。对于弦长大于6.6毫米（9-0）的针，在下肢总能更好地检测到。在理想条件下，资深观察者能检测到7.1%的较小针。
手术中针丢失时，在安排荧光透视前应考虑以下情况。弦长大于13毫米（6-0）的针应能可靠检测到，而3.8毫米（10-0）的针则不能。对于介于两者之间的尺寸，理想的检测条件可能包括下肢的手术区域、高分辨率荧光透视和资深观察者。用荧光透视识别显微手术针可能没有必要或不具成本效益。
