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Finding What Surgeons Leave Behind

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SAN DIEGO, Calif. ( Ivanhoe Newswire) - Every day they're used to soak up blood during thousands of surgeries across the country. But one in 1,500 surgeries sponges are left inside patients' bodies. In up to 35 percent of those cases, the patient will die. Now, there's an extra set of eyes to help surgeons see what they may be missing.

Lenny Leclair went to the hospital for a routine surgery.

"I never stopped throwing up," Lenny Leclair told Ivanhoe.

But he left much worse than he came in.

"I thought I was dying," Lenny said.

A scan revealed doctors had left a gauze sponge inside Lenny during the surgery. It pierced his colon.

"It was like a septic tank in there," Lenny said.

Lenny's case is not unusual.

"In the operating room, it's not uncommon, several times a month, the sponge count is off," Anthony Perricone, M.D., a cardio-thoracic surgeon at UC San Diego, said.

Until recently, unless surgeons re-open the patient, there was no way of knowing if the missing sponge was left inside or put in the trash.

"When you're done with your operation, you can wave the wand over it, and it will beep," Dr. Perricone said.

Doctor Perricone is part of a new generation of doctors using an RF sponge detection system in the OR, and the next generation of sponge detection is a mat, which automatically scans the body and warns the surgeon of any sponges they forgot about.

New technology in the OR that helps surgeons "see" what they may have left behind before it's too late. A study finds sponges are left behind the most when patients are male, or have a large BMI, or if their procedure is longer than four hours. More than 2,000 operating rooms in over 150 hospitals are using the RF assure system for detecting sponges.

RESEARCH SUMMARY

BACKGROUND: As many as one out of 1,000 people who undergo abdominal surgery end up in the recovery room with a foreign object mistakenly left inside them. In the medical community, these forgotten surgical tools are known as "retained foreign objects." The object most commonly left behind is the surgical sponge which is used to soak up fluids during surgery. Sometimes these forgotten sponges are not discovered for years, if at all. For decades, surgical teams have relied on counting — and recounting — the sponges, needles, blades, retractors, and other items used during operations.  Sponges left inside patients can cause infections and other complications. If left inside, the sponge usually has to be removed with another surgery. (Source: Time Magazine)

  • 62 percent of retained surgical items were detected after the surgical count was reported as correct (Cima 2008)
  • 76 percent-88 percent of all retained surgical objects involve falsely correct sponge counts
  • 10 percent-15 percent of all retained objects involved having an X-ray
  • Sponge counts do not match in 10percent of major cases resulting in recounts and verifications
  • Mortality related to RFO's ranges from 11 percent to 35 percent

LOST AND FOUND:  RF Surgical Detection Technology uses a low energy radio frequency signal capable of locating misplaced surgical items prior to wound closure through blood, dense tissue, bone and performs well near metals. Each of the hospital's sponges, which actually are thin cotton cloths, has a thin, tiny chip embedded in a seam. The chip, which is about the size and shape of a grain of rice, emits a low-frequency AM radio signal. Doctors or nurses can detect the chip with a wand, a large plastic circle that plugs into a small box, waved over the patient. If there is a sponge still inside the patient, the wand will beep, and the surgeon will know approximately where the sponge is. The wand can detect a sponge up to two feet away. The wand can be used numerous times over 24 hours, and then has to be discarded.

The sponge-detection technology is used on several categories of "high-risk" patients: Patients undergoing emergency surgery, obese patients, women giving birth  and patients having surgery on more than one area of the body. (Source: RFsurg.com)

INTERVIEW

Dr. Anthony Perricone, a Professor of Surgery in the division of Cardio Thoracic Surgery at the University of California in San Diego, talks about detecting dangerous surgical supplies doctors may leave inside your body!

This is a problem that you don't hear a lot of but it's more common than you think right?

Dr. Perricone: The retained sponge or---in the parlance of a radiologist---a retained foreign body, probably occurs in about one in fifteen hundred cases.

And what can that do?

Dr. Perricone: Usually, it would require a second operation to remove the sponge. And then there would be additional pain, suffering and disability for the patient who has to undergo a second operation. The thing about the sponge is it might not reveal itself right away. It may not reveal itself for six months or several years. It will usually present as a festering, recurrent, low grade infection. It isn't until you've done the necessary imaging that you may discover there's a retained foreign body. If you're lucky, the patient might have had a post-operative x-ray that reveals the retained sponge before it causes any symptoms Then the surgeon can go and fish it out before it starts to cause any problems.

Can you die from this?

Dr. Perricone: I'd rather not say because that's a loaded question, but it certainly will compromise your health. Again if you have a retained foreign body that's causing indolent recurring infection, there's a certain amount of complications associated with that.

Tell me the premise behind the radiofrequency device on the sponge.

Dr. Perricone: The sponge has a tag attached that is detected when a radiofrequency signal is passed over it. When you're done with your operation, you can wave a special wand over the patient. Another option is a special pad the patient can be laying on. It has sensors built in and will beep if a tagged sponge is detected.

How does the system work?

Dr. Perricone: It's similar to radar that's emitting a low frequency radio wave that will then bounce off of the radiofrequency tag attached to a sponge.

Is this being used in the OR yet?

Dr. Perricone: Yes. We've used it routinely at the University of California. (RF Assure technology is used in more than 2,500 operating rooms nationwide.)

Why do you consider this a breakthough?

Dr. Perricone: In the operating room, it's not uncommon several times a month to hear that the sponge count is incorrect. You're then kind of stuck with this dilemma: Do you go back inside after your operation and start moving all the organs around looking for the sponge, or do you have the nurses pull all the trash cans out to see if two sponges were stuck together and they counted one when there should have been two? This happens pretty regularly. As a surgeon, it's really comforting to know when they say, "Our sponge count is incorrect," you can wave the wand over the patient or trash can. If you hear the electronic controller beeping, then you know if you have to go on a diligent search to get this sponge. If you wave the wand over the patient and don't hear anything, you are pretty confident it's not in the patient, which saves a lot of time.

How stressful is the thought you might have left a sponge inside a patient?

Dr. Perricone: It would be stressful if the sponge count is incorrect by one and they never find it. Then you have to leave the operating room not knowing where that sponge is. You have to do imaging hoping that you'll detect the sponge on the imaging. It may not sometime reveal itself until several days later when a lot of the swelling around the operative site resolved, and then you might see that retained sponge. I think that probably happens not infrequently where someone did a routine x-ray afterward and they don't see the sponge, but maybe a week or so later after the operative field is allowed to clear up, they can now detect their retained sponge or foreign body.

How many sponges do you use in a normal surgery?

Dr. Perricone: Probably anywhere between ten to a hundred sponges depending upon what the operation is. (Radiofrequency tags are) a simple idea that really helps a lot. Not just because one in fifteen hundred sponges on average are left in patients, but because you immediately know where to look for this sponge; in the patient or in the trash can.
 

FOR MORE INFORMATION, PLEASE CONTACT:

Emily Crump
MarComm Manager
760-822-8508
Ecrump@rfsurg.com

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