Looking for a needle in a haystack: Recovering tiny metal fragments of broken instruments during pediatric laparoscopic surgery

Objective: The purpose of this study was to investigate the management of the rare case that tiny metal fragments of broken instruments falling into the abdominal cavity during pediatric laparoscopic surgery. Methods A retrospective review of patients with tiny metal fragments of broken instruments during pediatric laparoscopic surgery in our hospital. In addition, we searched and analyzed the relevant literature from 1 January 2000 to 31 December 2021 from the PubMed, EMBASE, and Cochrane Library databases. Results 2 cases with tiny metal fragments of broken scissors during laparoscopic surgery were successfully recovered in our hospital. Together with our 2 cases, a total of 13 cases were reported instrument broken during laparoscopic surgery. 3 cases visible and other 10 cases underwent intraoperative fluoroscopy; 4 cases were taken out by the magnetic device; 1 case converted to a laparotomy; none of them result in retained surgical instrument. Management of the rare case mainly includ careful search, necessary fluoroscopy and magnet. First, stop the operation immediately. Then the environment was carefully viewed with unnecessary turning as much as possible. Next intraoperative fluoroscopys was used. A magnet was put into the abdominal cavity. After the metal foreign bodies were removed, fluoroscopy again for ensuring that the foreign body is removed without residue. Conclusions Management of recovering tiny metal fragments of broken instruments during pediatric laparoscopic surgery mainly includes careful view, necessary fluoroscopy and magnet.