Lost Needle During Gynecologic Laparoscopic Surgery: A Literature Review and a Suggested Approach

Laparoscopic suturing is an important component of advanced gynecologic procedures. A needle may be inadvertently lost, and searching for it can be especially challenging. The goal of this review is to present useful strategies when this problem occurs. This article reviews current literature and suggests a structured approach for retrieving a lost needle. Preventive measures that reduce the risk of the needle being lost are also highlighted. A systematic search of a lost needle should cover all areas of the gynecologic surgical field, including the abdominal cavity, abdominal wall, laparoscopic cannulas, and the surrounding area. Intraoperative imaging, such as plain film X-ray or C-arm fluoroscopy, has been shown to be useful for localizing lost needles. The benefits and risks of conversion to laparotomy should be carefully evaluated if the needle remains missing after a prolonged search. The 7-step approach described in this article can be followed by laparoscopic surgeons faced with lost-needle occurrences. (J GYNECOL SURG 39:60)