Laparoscopic surgery, intraoperative management of the lesion went quite well, but when the suture was completed, the needle held the clip thread and pulled it up to the poke card and the thread came out ...... the needle was missing!

In the repeated suspicion, entanglement, a full four hours have passed, the lost needle is really like falling into the sea without a trace.
At this moment, the doctor in charge of the heart of the anxiety I believe most of my colleagues can appreciate.
He had no choice but to inform the family and get their signature to stop the operation, and then turned to the radiology department for gastrointestinal fluoroscopy.
Fortunately, under gastrointestinal fluoroscopy, the missing needle was finally revealed!

The needle was found, however, the problem arose again, the poke card that came out of the needle was in the left lower abdomen, how did the needle get to the right upper abdomen and on top of the liver under the diaphragm?

Analysing the possible reasons
1. Due to the pneumoperitoneum, the intra-abdominal space is wider and the needle has a wide range of movement.
2. With the head in a low position, the needle will move towards the diaphragm with gravity after it is dislodged.
3. The space between the liver and the abdomen is large and the needle moves effortlessly above the liver under the diaphragm.
So, back to the operating room, anaesthesia, create a pneumoperitoneum, and after pulling down the hepatic round ligament under the mirror, we saw that part of the suture tape was tightly adhered to the diaphragm, and it was taken out under direct vision.

Lessons learnt
1. When suturing under laparoscopy, the suture must not leave the field of view.
2. When removing the needle, it must be retracted into the poke card and removed under direct vision of the laparoscope.
3. Once dislodged and dropped into the body, it is likely to run into the subphrenic or pelvic cavity. If conditions permit, you can repeatedly flush and change the patient's position to be as upright as possible, and then go to the lowest position to look for it.
4. If still can not be found, as soon as possible with the help of imaging tools, note that the C-arm is not everything, if necessary, need to carry out gastrointestinal fluoroscopy.