Artificial intelligence model for automated surgical instrument detection and counting: an experimental proof-of-concept study.

BACKGROUND: Retained surgical items (RSI) are preventable events that pose a significant risk to patient safety. Current strategies for preventing RSIs rely heavily on manual instrument counting methods, which are prone to human error. This study evaluates the feasibility and performance of a deep learning-based computer vision model for automated surgical tool detection and counting. METHODS: A novel dataset of 1,004 images containing 13,213 surgical tools across 11 categories was developed. The dataset was split into training, validation, and test sets at a 60:20:20 ratio. An artificial intelligence (AI) model was trained on the dataset, and the model's performance was evaluated using standard object detection metrics, including precision and recall. To simulate a real-world surgical setting, model performance was also evaluated in a dynamic surgical video of instruments being moved in real-time. RESULTS: The model demonstrated high precision (98.5%) and recall (99.9%) in distinguishing surgical tools from the background. It also exhibited excellent performance in differentiating between various surgical tools, with precision ranging from 94.0 to 100% and recall ranging from 97.1 to 100% across 11 tool categories. The model maintained strong performance on a subset of test images containing overlapping tools (precision range: 89.6-100%, and recall range 97.2-98.2%). In a real-time surgical video analysis, the model maintained a correct surgical tool count in all non-transition frames, with a median inference speed of 40.4 frames per second (interquartile range: 4.9). CONCLUSION: This study demonstrates that using a deep learning-based computer vision model for automated surgical tool detection and counting is feasible. The model's high precision and real-time inference capabilities highlight its potential to serve as an AI safeguard to potentially improve patient safety and reduce manual burden on surgical staff. Further validation in clinical settings is warranted.

Minimization of occurrence of retained surgical items using machine learning and deep learning techniques: a review.

Retained surgical items (RSIs) pose significant risks to patients and healthcare professionals, prompting extensive efforts to reduce their incidence. RSIs are objects inadvertently left within patients' bodies after surgery, which can lead to severe consequences such as infections and death. The repercussions highlight the critical need to address this issue. Machine learning (ML) and deep learning (DL) have displayed considerable potential for enhancing the prevention of RSIs through heightened precision and decreased reliance on human involvement. ML techniques are finding an expanding number of applications in medicine, ranging from automated imaging analysis to diagnosis. DL has enabled substantial advances in the prediction capabilities of computers by combining the availability of massive volumes of data with extremely effective learning algorithms. This paper reviews and evaluates recently published articles on the application of ML and DL in RSIs prevention and diagnosis, stressing the need for a multi-layered approach that leverages each method's strengths to mitigate RSI risks. It highlights the key findings, advantages, and limitations of the different techniques used. Extensive datasets for training ML and DL models could enhance RSI detection systems. This paper also discusses the various datasets used by researchers for training the models. In addition, future directions for improving these technologies for RSI diagnosis and prevention are considered. By merging ML and DL with current procedures, it is conceivable to substantially minimize RSIs, enhance patient safety, and elevate surgical care standards.

The Retained Surgical Items Risk Assessment Scale: Development and Psychometric Characteristics.

INTRODUCTION: Retained surgical items in operating rooms (ORs) continue to contribute significantly to medical errors. The first step in addressing the problem of retained surgical items is to identify the main risk factors. Identification of risk factors can impact OR standards and reduce such errors. METHODS: The research included 270 participants. The data of the study were collected with the Sociodemographic and Clinical Characteristics Form, Operating Room Count Control Form and the Retained Surgical Items Risk Assessment Scale developed. In the analysis of the data, Content Validity Index, Cronbach α, item-total score correlation, Kuder-Richardson, Kappa, exploratory and confirmatory factor analysis, and Receiver Operating Characteristic (ROC) curve analysis were performed. RESULTS: The Content Validity Index of the scale was 0.92. Kappa value was 0.993. The explained variance in the exploratory factor analysis of the scale was 50.03%. After confirmatory factor analysis, two factors were obtained for the final version of the 15 items. Factors had been determined as "Count and Surgery" and "Equipment". Among the subdimensions of the scale, Cronbach's α values were between 0.742 and 0.760, and 0.722 for the entire scale. When the ROC analysis results were examined, the cut-off point was ≥8, the specificity was 93.13%, and the sensitivity was 87.50%. The area under the ROC curve was calculated as 0.938. CONCLUSIONS: The scale was presented as a valid and reliable measurement tool developed to assess the Retained Surgical Items Risk in ORs. If high-risk patients are checked and necessary precautions are taken before leaving the ORs, the incidence of retained surgical items can be significantly reduced.

Retained surgical item in inguinal canal of a patient with bilateral inguinal hernia: a case report.

Retained surgical items that remain inside patient's body during operation are linked to increased mortality, morbidity and negative financial consequences. This case reports a 65-year's-old male nurse with bilateral inguinal swelling. With history of right sided inguinal hernia 8 years ago that underwent open repair without mesh. Swelling was reducible on right side only, positive visible and palpable cough impulse bilaterally, and surgical scar on right iliac region. Diagnosed as left side inguinal hernia with recurrent right side inguinal hernia. After informed consent and preoperative assessment, open repair started with right side, sac excised after reducing content and mesh placed. Same procedure done on left, surgical gauze was found in inguinal canal and removed successfully, operation completed. Patient did well on follow-up. Collaboration and communication is crucial between staff during operations to prevent errors and promote safety.

Surgical items retained in the abdominal cavity in diagnostic imaging tests: a series of 10 cases and literature review.

Despite improvements in the safety of surgical procedures, leaving a foreign object in a patient's body is still one of the complications of surgical procedures. The literature lacks an analysis of the effectiveness of specific diagnostic tests in detecting foreign objects. The authors present a discussion of the effectiveness of selected techniques and examples of the appearance of foreign bodies in radiological images based on the description of 10 cases. Leaving surgical haemostatic material in the abdominal or pelvic cavity is an underestimated phenomenon that poses a serious diagnostic problem. Computed tomography is the most sensitive method for detecting a foreign body, while a chest or abdominal X-ray is the simplest and most effective way to identify the surgical material. Ultrasound, although widely available, has not shown utility in diagnosing foreign bodies in our cases. Awareness of this problem is necessary to avoid unnecessary mortality in surgical patients.

Modification of Polyvinyl Chloride Composites for Radiographic Detection of Polyvinyl Chloride Retained Surgical Items.

The ever-present risk of surgical items being retained represents a real medical peril for the patient and potential liability issues for medical staff. Radiofrequency scanning technology is a very good means to substantially reduce such accidents. Radiolucent medical-grade polyvinyl chloride (PVC) used for the production of medical items is filled with radiopaque agents to enable X-ray visibility. The present study proves the suitability of bismuth oxychloride (BiOCl) and documents its advantages over the classical radiopaque agent barium sulfate (BaSO4). An addition of BiOCl exhibits excellent chemical and physical stability (no leaching, thermo-mechanical properties) and good dispersibility within the PVC matrix. As documented, using half the quantity of BiOCl compared to BaSO4 will provide a very good result. The conclusions are based on the methods of rotational rheometry, scanning electron microscopy, dynamic mechanical analysis, atomic absorption spectroscopy, and the verification of zero leaching of BiOCl out of a PVC matrix. X-ray images of the studied materials are presented, and an optimal concentration of BiOCl is evaluated.

The effectiveness of radiofrequency scanning technology in preventing retained surgical items: An integrative review.

AIMS AND OBJECTIVES: To synthesise evidence on the effectiveness of radiofrequency (RF) scanning technology as an adjunct to manual counting protocols in preventing retained surgical items (RSIs) in the operating room. BACKGROUND: Despite the implementation of rigorous manual counting protocols, RSIs remain one of the most common reported sentinel events in operating theatres that lead to adverse patient outcomes. DESIGN: An integrative review. METHODS: This review was guided by the Whittemore and Knafl (2005) framework. A literature search using CINAHL, MEDLINE, ProQuest, PubMed, and Scopus with key search terms related to RSIs and RF was applied to select English articles from January 2011 till August 2021. The Joanna Briggs Institute (JBI) Critical Appraisal Checklist was utilised for study quality assessment while reporting of review was guided using the PRISMA checklist. RESULTS: A total of 15 peer-reviewed articles were included, enabling the knowledge on the RF scanning technology to be grouped into four themes, namely: detection accuracy of RF scanning technology, real-time detection of surgical items using RF identification, the impact of the RF scanning technology for detecting RSIs on patient safety, and cost-analysis of integrating the RF scanning technology in operating theatres. CONCLUSION: Radiofrequency scanning technology is effective in preventing RSIs with significant cost-savings. Perioperative leaders should develop a multidisciplinary process to evaluate and select the most appropriate RF scanning technology as part of their patient safety programs. However, future studies with a larger sample size and robust research design, such as randomised controlled trial, should be considered to enhance the generalisability and rigour of evidence. RELEVANCE TO CLINICAL PRACTICE: This review contributes to perioperative personnel's education/training of staff on using RF scanning technology to prevent RSIs. The cost-effectiveness analysis enables the healthcare leaders to decide on the selection of appropriate RF technology.

Characteristics of retained foreign bodies and near-miss events in the operating room: a ten-year experience at one institution.

PURPOSE: Retained foreign bodies (RFBs) are a major complication of surgical procedures. However, the efficacy of preventive measures is not well defined. This study investigates the characteristics of potential (near miss) and actual RFBs, and the contributions of routine practice for the prevention of RFB events. METHODS: We conducted a retrospective review of incident reports regarding near-miss and RFB events in patients who underwent surgery under general anesthesia in our institution between October 2008 and November 2018. RESULTS: Among 49,831 operations under general anesthesia, there were 106 (2.13/1000) near-miss events and 24 (0.48/1000) RFB events. Counting surgical materials and intraoperative X-rays detected the remaining items before completion of surgery in 59 (56%) and 15 (14%) cases, respectively. The operator or staff noticed the surgical materials in the remaining 32 (30%) near-miss events. RFBs included 4 sponges (17%), 4 instruments (17%), 4 needles (17%), and 12 miscellaneous items (50%). Of these, 12 (50%) RFBs were discovered on postoperative X-rays and 16 (67%) patients required operative removal. Four incidents (17%) with RFBs were attributable to ignoring count discrepancies during surgery. CONCLUSION: The actual incidence of RFB events is higher than previously reported. A standardized counting protocol, communication among staff, and intra- and postoperative X-rays may contribute to the prevention and detection of RFBs.

Guidelines in Practice: Prevention of Unintentionally Retained Surgical Items.

Retained surgical items (RSIs) are adverse events that can affect patients, surgeons, and nurses. Interdisciplinary teams should work to standardize surgical item accounting processes and help all perioperative team members prevent RSIs. AORN recently revised the "Guideline for prevention of unintentionally retained surgical items," which provides background information on RSIs and ways to prevent them. The revised guideline describes the role of team communication coupled with specific nursing actions aimed at preventing RSIs. This article reviews key concepts from the guideline and discusses new or changed recommendations regarding a consistent interdisciplinary approach and standard counting procedure; accounting for soft goods, sharps and miscellaneous items, instruments, device fragments and explants, and foam pieces; reconciling count discrepancies; adjunct technology; and education. The article also provides a scenario related to implementing adjunct technology to prevent RSIs. Perioperative leaders and nurses should review the guideline in its entirety and apply the recommendations to prevent RSIs.

Addressing the important error of missing surgical items in an operated patient.

BACKGROUND: We aim to analyze the characteristics of incidences of missing surgical items (MSIs) and to examine the changes in MSI events following the implementation of an MSI prevention program. METHODS: All surgical cases registered in our medical center from January 2014 to December 2019 were retrospectively analyzed. RESULTS: Among 559,910 operations, 154 MSI cases were reported. Mean patient age was 48.67 years (standard deviation, 20.88), and 56.6% were female. The rate of MSIs was 0.259/1000 cases. Seventy-seven MSI cases (53.10%) had no consequences, 47 (32.41%) had mild consequences, and 21 (14.48%) had severe consequences. These last 21 cases represented a rate of 0.037/1000 cases. MSI events were more frequent in cardiac surgery (1.82/1000 operations). Textile elements were the most commonly retained materials (28.97% of cases). In total, 15.86% of the cases were not properly reported. The risk factors associated with MSIs included body mass index (BMI) above 35 kg/m2 and prolonged operative time. After the implementation of the institutional prevention system in January 2017, there was a gradual decrease in the occurrence of severe events despite an increase in the number of MSIs. CONCLUSION: Despite the increase in the rate of MSIs, an implemented transparency and reporting system helped reduce the cases with serious consequences. To further prevent the occurrence of losing surgical elements in a surgery, we recommend educating OR staff members about responsibility and obligation to report all incidents that are caused during an operation, to develop an event reporting system as well as "rituals" within the OR setting to increase the team's awareness to MSIs. Trial registration Clinicaltrials.gov (NCT04293536). Date of registration: 08.01.2021. https://clinicaltrials.gov/ct2/show/NCT04293536 .

Incorrect Surgical Counts: A Potential for Retained Surgical Items.

BACKGROUND: In the main operating rooms of a large academic hospital there was a report of 408 count discrepancies in 2015-2016 and 13 incidences of retained surgical items (RSIs). There was a lack of a consistent and standardized surgical count process among nurses. OBJECTIVES: To reduce count discrepancies by 25%, prevent RSIs, and improve the compliance of the perioperative nursing team regarding the surgical count process. METHODS: An evidence-based quality improvement project with a sample of 455 surgical procedures and 118 nurses. Data collection occurred over an eight-week period in 2018 using a Plan-Do-Study-Act (PDSA) methodology to study the effectiveness of the utilization of the Association of periOperative Registered Nurses (AORN) practice guidelines for the prevention of RSIs. RESULTS: The inclusion of risk reduction strategies such as the utilization of an AORN guideline whiteboard to record surgical items and the identification of high-risk items for retained device fragments or high-risk surgical items for RSIs resulted in the reduction of incorrect surgical counts by 71.43%, with no incidence of RSIs. Further, nurse compliance on surgical count practices improved significantly, F (5, 46) = 2.47, p = .046, PES = .21. CONCLUSION: The implementation of the AORN guidelines for perioperative surgical count practices by the perioperative nursing team provided an improved surgical count process. IMPLICATION FOR NURSING: A system approach to performance improvement is needed to prevent RSIs.

A comparative study on patient safety attitude between nurses and doctors in operating rooms.

OBJECTIVE: To investigate and compare the attitudes of operating room nurses and doctors regarding patient safety, performance of surgical time-out and recognition of count error. METHODS: This cross-sectional study recruited operating room nurses, surgeons and anaesthesiologists between 1 August 2015 and 5 February 2016. A Safety Attitude Questionnaire was used to analyse the three elements in both groups of operating room staff (nurses and doctors). RESULTS: The study analysed the questionnaires from 171 participants; 95 nurses (55.6%) and 76 doctors (44.4%). Differences exist between doctors and nurses regarding teamwork climate, working conditions, perception of management and the recognition of stress. On the performance of surgical time-out, nurses showed higher scores on way of counting, while doctors showed higher scores on the time-out procedure itself. Also, doctors believed they actively cooperated with the nurses, while nurses believed they did not receive cooperation. Scores for the recognition of count error were higher in nurses than in doctors. More experienced operating room staff showed higher scores than younger less experienced staff. CONCLUSIONS: Perceptual differences among doctors and nurses need to be minimized for the safety of the patient in the operating room.

Retained Surgical Items in Inguinal Canal: A Case Report and Literature Review.

BACKGROUND: Retained surgical items (RSI) are rare medical challenges with serious complications and medicolegal implications. Knowledge and preventive measures for these rare events are currently not sufficient to limit their increasing incidence. Gauzes and sponges constitute most of RSI. Forceps, needles and pins may be found too. Diagnosis of these events is challenging and often missed due to nonspecific clinical findings. PRESENTATION OF CASE: We present here a 49-year-old patient who presented to the clinic with a history of chronic scrotal sinus on the same side of a repeatedly repaired inguinal hernia 4 months before admission. He underwent exploration of the inguinal canal as elective surgery. Exploration of the inguinal canal revealed missed surgical gauze left during the previous hernia repair. The gauze was removed, and the inguinal canal was repaired. The postoperative period was uncomplicated. CONCLUSION: Retained surgical items are completely preventable near-events. Although they are rare entities, clinicians must have a high index of suspicion for any postoperative, in patients presenting with pain, sinus or palpable masses.

Transmigration of a retained surgical sponge: a case report.

BACKGROUND: A retained surgical sponge remains a dreaded complication of modern surgery. Despite the increasing focus on patient safety instances of "a sponge being left in the abdomen", are all too common in popular media. In this article we report the rare phenomenon of transmigration of a retained surgical sponge in a patient who underwent laparoscopic sterilization. CASE PRESENTATION: A 30-year-old female presented with progressive abdominal pain for about one month and vomiting with obstipation for 2 days. The patient had undergone laparoscopic sterilization 7 years back and then underwent re-canalization one year back. She underwent an exploratory laparotomy for suspected adhesive small bowel obstruction. During surgery, an intra-luminal surgical sponge was recovered from the distal small bowel. The patient recovered and was discharged in good health. CONCLUSION: Despite numerous advances in terms of technology and the ever-growing emphasis on patient safety, the problem of a retained surgical sponge remains a dreaded potential complication. All clinicians and health care professionals should be aware of this entity and its various presentations.

Experience of a Tertiary-Level Urology Center in the Clinical Urological Events of Rare and Very Rare Incidence. I. Surgical Never Events: 2. Intracorporeally-Retained Urological Surgical Items.

OBJECTIVE: Presentation of our center's experience in the management of intracorporeally-retained urological surgical items. MATERIALS AND METHODS: Retrospective search of our center's data for cases of retained surgical items during the period July 2006 to June 2016. Each case was studied for the demographic and clinical variables including types, presentation, and management. RESULTS: Out of more than 55,000 different urological interventions, only 39 cases (28 males and 11 females) had retained surgical items. Urolithiasis-related urological subspecialties were more involved than others. Forgotten items and technically-retained items occurred in 38.5 and 61.5% of cases, respectively, and were immediately discovered or discovered up to 10 years later. Material types were textiles, biosynthetics, and metallics in 31, 51, and 18%, respectively. Possible predisposing factors included complex surgeries, emergent intraoperative events, and extra approaches. Occurrences of retained surgical items before and after implemented corrective actions were 74.6 and 25.4%, respectively. All the final outcomes were either short- or long-term harm without deaths, organ losses, or permanent disabilities. CONCLUSION: Retained urological surgical items are surgical never events that result from forgetfulness or technical surgical human errors. Their sequels can be potentially fatal, but they are preventable and can be significantly reduced.

Imaging of retained surgical items: A pictorial review including new innovations.

With the advent of newer imaging modalities retained surgical items are now easily diagnosed by their characteristic imaging appearances. A combination of complementary imaging modalities helps to arrive at the diagnosis of this relatively rare complication. Factors contributing to their imaging features include the timing of diagnosis and imaging, presence of secondary infection, communication of the retained item with hollow viscus or external skin wound, and type of imaging modality used. A high index of suspicion is necessary for diagnosis before labeling it as a retained surgical item. In parallel with recent advances in surgery, it is essential that there is increasing awareness among radiologists regarding the newer types of retained surgical items.

How many people work in your operating room? An assessment of factors associated with instrument recounts within plastic surgery.

BACKGROUND: Intraoperative instrument recounts are performed to avoid retained foreign surgical items. These additional counts, however, beget risks of their own, including prolonged operative times, exposure to radiation, and increased cost. Our study aimed to identify factors that increase the likelihood of instrument recounts during plastic surgery procedures, and use our findings to guide potential solutions for preventing unnecessary recounts across all surgical fields. STUDY DESIGN: This is a retrospective review of all plastic surgical cases in the main operating setting at New York University Langone Medical Center (NYULMC) between March 2014 and February 2015. RESULTS: Of 1285 plastic surgery cases, 35 (2.7%) reported a missing instrument necessitating a recount. Of all subspecialties within plastic surgery, only microsurgery conferred an increased risk of a recount event. We identified multiple factors that increased the odds of a recount event, including increased operative time, number of surgical sites, and intraoperative instrument handoffs. CONCLUSION: Instrument recounts, although designed to prevent inadvertently retained surgical items, present inherent risks of their own. In a large retrospective review of plastic surgery cases at our medical center, we identified many factors that increased the likelihood of an instrument recount. On the basis of our findings and prior literature, we recommend limiting the number of staff handling instrument, the number of handoffs, and a heightened awareness by surgeons and perioperative staff of specific procedures and factors that increase the risk of a miscount event.

Oblitoma en la cirugía ginecoobstétrica: un problema creciente. Reporte de un caso / Oblitoma in obstetric and gynecologic surgery: a growing problem

Resumen ANTECEDENTES: Los oblitomas, u objetos extraños retenidos en el abdomen posterior a una cirugía, son consecuencia de una iatrogenia que causa morbilidad, dificultad diagnóstica, problemas médico-legales, y complicaciones para las pacientes, el médico y la institución hospitalaria. CASO CLINICO: Paciente de 27 años de edad, con un cuerpo extraño retenido en la cavidad abdominal (bulbo de la cánula de Yankauer), olvidado durante una cesárea de urgencia. El diagnóstico y tratamiento fueron expeditos, con reintervención quirúrgica para extraer el cuerpo extraño, sin complicaciones y con evolución satisfactoria de la paciente. CONCLUSIONES: El estudio actual de los oblitomas u objetos extraños retenidos es un problema creciente, con estadísticas en contra, sobre todo asociadas con elevada frecuencia de cesáreas y alta prevalencia de obesidad materna durante el embarazo, esto debe alertar a los ginecoobstetras a conducirse con más cuidado para evitar este tipo de accidentes.

Abstract BACKGROUND: Oblitomas or retained surgical items (RSI) in the abdominal cavity after surgery are cause of iatrogenic medical problems, that origin high morbidity, difficult diagnosis and medical malpractice claims to may lead complications to patients, physicians included to hospital. CLINICAL CASE: We report an exceptional case, in a 27-year-old women, with a bulb of Yankahuer cannula retained in abdominal cavity, Forgotten during an emergency cesarean section. The diagnosis and management was realized with opportunity, avoiding complications. CONCLUSION: Actually, the study of oblitoma or foreign objects retained that's considered a growing problem, with statistics against it, mainly associated with high frequency of cesarean sections and high prevalence of maternal obesity during pregnancy. In fact, that situation place the gynecologists and obstetricians at a latent risk for this event. It is important to know the predisposing factors for its prevention and to implement institutional programs to reduce complications.

Surgical count process for prevention of retained surgical items: an integrative review.

AIMS AND OBJECTIVES: To analyse the evidence reported in the literature concerning the surgical count process for surgical sponges, surgical instruments and sharps and to identify knowledge gaps for future research on the surgical count process. BACKGROUND: The surgical count process stands out among the practices advocated by the World Health Organization to ensure surgical safety. The literature indicates that this practice should be performed in all surgical processes. However, surgical items are still retained. DESIGN: Integrative review. METHODS: The literature search was conducted in the PubMed, CINAHL and LILACS databases and included studies on the surgical count process published in English, Spanish and Portuguese from January 2003-December 2013. RESULTS: A total of 28 primary studies were included in the sample, allowing the knowledge on the surgical count process to be summarised and grouped into three categories: risk factors for retained surgical items, how the surgical count process should be performed in the intraoperative period and the accompanying technologies that collaborate to improving the manual count process. CONCLUSIONS: The correct implementation of the surgical count process by the perioperative nurse may contribute to preventing retained surgical items, thereby improving surgical patient safety. RELEVANCE TO CLINICAL PRACTICE: Nurses can use this review to assist in decision-making directed towards preparing, updating and implementing a reliable system for the surgical count process based on recent evidence because the perioperative nurse plays a key role in the implementation of this practice in health services.

Back to Basics: Counting Soft Surgical Goods.

Retained surgical items (RSIs) pose serious consequences for patients and are a significant threat to patient safety. Perioperative team members are morally and ethically responsible for the prevention of RSIs and should understand how to reduce the risk of occurrence. The prevention of RSIs does not rest in the hands of one individual. It is a multidisciplinary endeavor that aims to reduce the risk of RSIs, and team members should hold each other accountable. This Back to Basics article focuses on the process of counting soft surgical goods, which are the most common RSIs.