Loss of a Needle During Laparoscopic Surgery

Why It Happens

• The needle slips off the needle holder while being passed through a trocar
• The needle deflects off tissue and becomes airborne inside the peritoneal cavity
• The needle is partially withdrawn into the trocar shaft and lost in the abdominal wall layers
• The needle breaks, leaving a fragment behind

Step-by-Step Retrieval Protocol

• Inform the whole team. Do not move the patient or change port positions until a search is completed.
• Document the time of loss.

• Remove and inspect the trocar shaft - the needle is very commonly caught just inside the sleeve.

• Move the laparoscope from the main port and examine all quadrants methodically.
• Reduce pneumoperitoneum slightly to prevent the needle from migrating further.
• Look in dependent areas (pelvis, paracolic gutters) where needles tend to fall by gravity.

• A laparoscopic magnetic retriever is considered the safest and most efficient tool for ferromagnetic needles.
• Pass it through a 5 mm port and sweep across the peritoneal surfaces.
• Research by Barto et al. (PMID: 21857450) confirmed this as the method of choice.

• Once visualized, grasp the needle directly with a laparoscopic needle holder or atraumatic grasper.
• Withdraw the needle tip-first through the trocar to avoid catching on the sleeve.

• A 2025 video article published by ISGE (DOI: 10.36205/trocar6.vid25013) demonstrated a novel technique: a 5 mm operative hysteroscope with CO2 insufflation is introduced into the trocar wound. The hysteroscopic grasper then retrieves the needle under direct vision from the abdominal wall layers. This is useful when the needle escapes into the port site wound.

• If all laparoscopic attempts fail, intraoperative fluoroscopy can localize a radiopaque needle.
• A plain X-ray of the abdomen is the fallback to confirm needle is accounted for before closing.

• If still not found, a portable X-ray in the OR must be performed. This is a medicolegal requirement.

Dedicated Retrieval Devices

Video Resources

1. Robotic/Laparoscopic Needle Retrieval - JMIG Video - Published in the Journal of Minimally Invasive Gynecology, this video describes instruments and techniques to locate and retrieve lost needles and fragments. This is one of the most cited surgical education videos on this topic.
2. A Novel Way to Manage Lost Needle in Laparoscopic Surgery - ISGE Video Article (2025) - A 2025 video article demonstrating hysteroscope-assisted retrieval from a port site wound.
3. 6 Most Common and Efficient Techniques for Laparoscopic Needle Positioning - YouTube - Covers needle handling and positioning techniques that help prevent loss in the first place.
4. World Laparoscopy Hospital - Laparoscopy Videos - An extensive library of laparoscopic surgical videos including needle techniques from Dr. R.K. Mishra.