An intraoperative method of localizing a missing piece of a broken laparoscopic instrument

Abstract

Missing a laparoscopic needle or a dislodged broken piece of a laparoscopic instrument presents a challenge in localizing it. A fragment of a broken instrument is often confined in an area remote from the primary operative side and entrapped in the bowel loop or in the omentum. An abdominal x-ray film identifies a missing part of the instrument intraabdominally; however, it is extremely difficult to find it with a laparoscope. A precise small area and a reference point are needed to establish where the dislodged missing fragment part is. The radiopaque threads from x-ray-detectable sponges were removed and placed on the abdominal skin, creating a net. With the target square determined by radiopaque threads, finding and removing the dislodged missing piece were achieved very expeditiously. This technique to localize a missing piece of a broken laparoscopic instrument intraabdominally is simple, inexpensive, and noninvasive, allowing expeditious removal and saving substantial operative time.