Lindsay Nelson, DO, Alexander Marinica, DO, Fazaldin Moghul, DO, Abubaker Ali, MD, FACS. Detroit Medical Center/Sinai-Grace Hospital
Introduction: Robotic toupe fundoplication is an accepted treatment for symptomatic hiatal hernias. A retained needle is a feared complication of minimally invasive surgery and no single accepted best practice exists for retrieval. In this case report, a lost needle is ultimately determined to be within the chest cavity after robotic abdominal surgery.
Case Presentation: 78 year old female with nausea and vomiting as well as pulmonary embolism after a knee replacement is found to have an obstructing type two hiatal hernia. Work-up demonstrated a gastric outlet obstruction secondary to volvulus. She underwent a robotic toupe fundopliation using the SI platform. Needle count at the conclusion of the procedure was one needle short. Robotic exploration, laparoscopic exploration with spleen mobilization, and left VATS were performed without successful retrieval. The procedure was concluded with the retained needle left in place. The patient recovered from surgery without any longterm complications to date. She remains asymptomatic, electing to forego further intervention to obtain the retained needle.
Discussion: Storing needles in the diaphragm during robotic surgery can increase the risk of retention, though no known cases to date have reported the loss of a needle through the diaphragm into the chest cavity. Proposed exploration via open laparotomy is one of the common options for locating a retained needle. In this case, laparotomy would have been unnecessary and unsuccessful, as post-operative CT scan demonstrated the needle within the costophrenic sulcus. The attached video abstract demonstrates the performed procedure and details the case of a lost needle in the left chest cavity and attempted localization. Practice changes will include removal of each needle after its use, rather than placing needles in the diaphragm intraoperatively to await mass removal at the conclusion of the procedure.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 93175
Program Number: V165
Presentation Session: Video Loop Day 1
Presentation Type: VideoLoop