Retained needles in laparoscopic surgery: open or observe?

Background: Currently, there is no standard of care on how to manage a retained needle or foreign body (RFB) during laparoscopic surgery.

Methods: A survey presented a relevant case and 18 multiple-choice and open-response questions about personal experience with and attitudes toward RFBs, clinical practices, and management.

Results: From 10/2009-2/2010 we received 255 survey responses. When faced with a patient with a RFB, 45.8% would convert to open, 26.5% would leave needle intraperitoneally, and 27.7% would seek the patient's or family's wishes. When the latter option was eliminated, 54.5% would convert to open, 45.5% would leave the needle intraperitoneally. There were 92.6% who felt that a RFB puts the patient at some degree of future risk, and 89.4% who felt that escalating to laparotomy was of higher risk than the RFB itself.

Conclusion: No current best practice exists regarding approach to RFBs of uncertain injury potential in laparoscopic surgery and similarly in this survey, opinions were split regarding how to proceed.