Dr. B. Devika Ranicompleted her MBBS in 1986, DGO in 1991 and MD in obstetrics and gynaecology in 1992 from prestigious medical college of Thiruvananthapuram, Kerala. She worked in Kerala Health Service for 2 years and then continued her practice in private hospital. She has 27 years of experience in obstetrics and gynaecology. Her field of interest is laparoscopy and infertility. She is currently working in Cosmopolitan Hospital Thiruvananthapuram for the past 20 years as a senior consultant and teaching faculty of DNB.
Dear editor,
The aim of this review is to elucidate the extent of RSI
(retained surgical instrument) in MIS (minimally invasive
surgery). It’s a misperception that MIS is safer with regard
to risk of retention of instruments in body cavities. Even in
MIS, there is a chance of losing small gauze piece, broken
needles and broken tip of instruments in body cavities. We
want to share our experience with regard to a rare instance
of RSI during laparoscopy. Our patient underwent TLH with
BSO for endometriosis and fibroid uterus. After surgery, we
presumed that claws are intact so we didn’t open the claws
and examine for any missing claws. Six hours after completion
of surgery, while cleaning instruments, part of a claw
of harmonic scalpel was found missing. We did an abdomen
and pelvis X-ray which showed a small radio-opaque foreign
body of size 1 cm in pelvis. Informed consent was taken,
and laparoscopy was performed the next day. Abdomen was
visualised through the same ports, and a search for the foreign
body under the guidance of C-arm was done. It was
located and removed through the same ports and identified
as the claw of harmonic scalpel as suspected (Fig. 1). Patient
made an uneventful recovery after the procedure.
We know that retention has very little to do with patient
characteristics, and it’s the operation room culture which
matters. The definition of RSI is: surgical item is considered
to be retained when it is found within the patient body
after the patient is out of the operation theatre [1]. It can be
discovered hours to years after the initial operation, and usually
a second surgery is required for its removal. Retained
sponges and instruments due to surgery is a recognised medical
“NEVER EVENT” and has catastrophic implications over the patients. The multi-stakeholder operating room and
communication between each other will decrease the problems
of RSI. To work with multiple healthcare stakeholders
to make sure RSI becomes a true never event that was started
in 2004 [2]. Prevention of RSI policy was newly revised in
2015 to develop and disseminate evidence and experiencebased
best practices, derived from clinical event analysis and
the consensus effort of groups of perioperative personnel.
Currently, there is no standard care on how to manage a
retained needle or small foreign body during laparoscopic
surgery. There are reports of complications associated with
retained surgical foreign bodies; however, the true risk of
RSI is not known. As there are no data other than individual
case reports on the frequency of retention in hospitals
around the world. RSI in laparoscopy whether to open or
observe is still debatable.
Conflict of interestAll the authors declare that they have no conflict of
interest and they have not received any grant.
Human and animal consentThis article does not contain any studies
with human or animal subjects, and it is a case report.
