腹腔鏡手術用持針器の破損・体内遺残に対して磁石デバイスを用いて回収した一例

抄録

  Various surgical instruments are routinely used for laparoscopic surgery, which represents a minimally invasive approach. However, retrieval of broken pieces of instruments/foreign bodies lodged in the abdominal cavity is challenging. We report a case of emergency laparoscopic surgery for a ruptured ovarian cyst in a patient who presented with a postoperative pelvic abscess in whom we identified a broken piece of a needle holder that was retrieved following reoperation 11 months after the initial surgery. The patient was referred to our department after computed tomography revealed a pelvic mass (9 cm in length). She underwent emergency laparoscopic-assisted ovarian cystectomy for a ruptured left ovarian endometrial cyst. Intraoperatively, the suture needle and thread could not be grasped, and the instruments were replaced. Postoperatively, the patient developed a pelvic abscess and was treated with antimicrobial agents. Magnetic resonance imaging performed on the 12^th postoperative day revealed a metal artifact, which led to the identification of a 1 mm-sized defect and remnants of a laparoscopic needle holder. The patient was asymptomatic and refused surgical retrieval of these items and was therefore observed. The foreign body was laparoscopically retrieved, 11 months postoperatively because it appeared to be immobile within the pelvis. Laparoscopic instruments are fragile. X-ray fluoroscopy and magnets are useful to retrieve small metal fragments.