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Gossypiboma
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Mini-laparotomy revealed gossypiboma (grasped by the clamp).
Surgical specimen (gossypiboma).

Gossypiboma, textiloma or more broadly Retained Foreign Object (RFO) is the technical term for surgical complications resulting from foreign materials, such as a surgical sponge, accidentally left inside a patient's body.

Etymology

[edit]

Gossypiboma is derived from Latin gossypium (cotton) and "-oma"(Greek combining element) meaning a tumor or growth.[1] Gossypiboma describes a mass within a patient's body comprising a cotton matrix surrounded by a foreign body granuloma.[2][3]

Textiloma is derived from textile (surgical sponges have historically been made of cloth), and is used in place of gossypiboma due to the increasing use of synthetic materials in place of cotton.[2]

Incidence and clinical presentation

[edit]

The actual incidence of gossypiboma is difficult to determine, possibly due to a reluctance to report occurrences arising from fear of legal repercussions, but retained surgical sponges is reported to occur once in every 3000 to 5000 abdominal operations[3] and are most frequently discovered in the abdomen.[4] The incidence of retained foreign bodies following surgery has a reported rate of 0.01% to 0.001%, of which gossypibomas make up 80% of cases.[2]

Gossypibomas can often present, clinically or radiologically, similar to tumors and abscesses, with widely variable complications and manifestations, making diagnosis difficult and causing significant patient morbidity.[4] Two major types of reaction occur in response to retained surgical foreign bodies. In the first type, an abscess may form with or without a secondary bacterial infection. The second reaction is an aseptic fibrinous response, resulting in tissue adhesions and encapsulation and eventually foreign body granuloma.[2] Symptoms may not present for long periods of time, sometimes months or years following surgery.[2]

Prevention

[edit]

To prevent gossypiboma, sponges are counted by hand before and after surgeries. This method was codified into recommended guidelines in the 1970s by the Association of periOperative Registered Nurses (AORN).[5] Four separate counts are recommended: the first when instruments and sponges are first unpackaged and set up, a second before the beginning of the surgical procedure, a third as closure begins, and a final count during final skin closure.[6] Other guidelines have been promoted by the American College of Surgeons and the Joint Commission.[7]

In most countries, surgical sponges contain radiopaque material that can be readily identified in radiographic and CT images, facilitating detection.[2] In the United States, radiopaque threads impregnated into surgical gauzes were first introduced in 1929 and were in general use by about 1940.[8] Some surgeons recommend routine postoperative X-ray films after surgery to reduce the likelihood of foreign body inclusion.[8]

See also

[edit]

References

[edit]
[edit]
Revisions and contributorsEdit on WikipediaRead on Wikipedia

Gossypiboma

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A gossypiboma, also referred to as a textiloma, cottonoid, or retained surgical item, is a postoperative complication involving the inadvertent retention of cotton-based surgical materials—such as , sponges, or towels—within a patient's at the conclusion of a surgical procedure. The term derives from the Latin word (meaning cotton) and the Swahili word boma (meaning place of concealment or hiding place), reflecting the concealed nature of the . First described in medical literature by C.P. Wilson in 1884, it represents a preventable iatrogenic error with significant clinical, medicolegal, and economic implications. Gossypibomas most commonly occur in intra-abdominal surgeries, particularly emergency procedures, though they can affect other sites such as the , , or soft tissues. The reported incidence varies across studies but is estimated at 1 in 1,000 to 1,500 abdominal operations (0.067%–0.1%), with some studies suggesting rates up to 0.3%–1% in certain contexts, particularly resource-limited settings due to underreporting driven by fear of litigation. Risk factors include prolonged or complex surgeries, emergency interventions, inadequate surgical team communication, high patient , and failures in intraoperative counting protocols for surgical items. Clinically, gossypibomas may remain for years or present with a wide range of manifestations, including , palpable mass, fever, intestinal obstruction, formation, adhesions, enterocutaneous fistulas, or even spontaneous expulsion through natural orifices such as the . These complications arise from the body's , which encapsulates the material in a matrix and can lead to chronic , , , or migration of the sponge. In severe cases, mortality rates can reach 25%, underscoring the urgency of timely detection. Diagnosis typically relies on a high index of suspicion based on surgical history, combined with modalities: plain X-rays may reveal radio-opaque markers on modern sponges, while ultrasonography detects hypoechoic masses with internal echoes, and computed (CT) provides the most sensitive visualization of spongiform patterns, air bubbles, or calcifications. Treatment invariably involves surgical removal via or to prevent ongoing complications, though conservative management with antibiotics may suffice for superficial or spontaneously draining cases. Prevention strategies emphasize meticulous sponge counts before, during, and after , the use of radio-opaque markers, and technologies like (RFID) systems or intraoperative scanning.

Definition and Etymology

Definition

A gossypiboma is defined as a pseudotumor consisting of a retained surgical or , typically composed of a matrix, that is inadvertently left within the body following a surgical procedure, often eliciting a surrounding inflammatory response. This condition, also known as textiloma, a term used for retained textile-based surgical materials, represents a specific subtype of retained surgical . Gossypiboma is classified as a "" in healthcare, signifying a serious, preventable iatrogenic that should not occur under standard surgical protocols. Its occurrence underscores failures in surgical counting and verification processes, leading to potential medicolegal consequences. These retained items most commonly manifest in intra-abdominal sites, such as following or cesarean section procedures, accounting for over half of cases; however, they can also occur in thoracic, retroperitoneal, or locations. The first reported case of such a retained was described in 1884.

Etymology

The term gossypiboma derives from the Latin gossypium, meaning "," and the Swahili boma, meaning "place of concealment," reflecting the hidden nature of the retained cotton-based surgical material within the body. A debated alternative interpretation suggests a combination of gossypium with the Greek -oma, denoting a tumor or abnormal mass, with a "b" inserted for euphony, emphasizing the pseudotumorous reaction. Alternative nomenclature includes textiloma, which refers to retained non-cotton textile materials such as synthetic meshes or gauzes, and retained foreign object (RFO), a broader encompassing any unintentionally left surgical item beyond textiles. These terms emphasize material composition or general category, respectively, while gossypiboma specifically evokes the cotton sponge's role in the condition. The evolved in the mid-20th century, with gossypiboma first documented in English in 1978 in a article titled "Gossypiboma—The Problem of the Retained Surgical Sponge," to supplant earlier, more accusatory phrases like "retained sponge" or "forgotten gauze," which carried pejorative implications of surgical . This shift promoted a neutral, descriptive label focused on the pathological entity rather than procedural error.

Epidemiology

Incidence

Gossypiboma, a retained surgical , occurs with an estimated incidence of 1 in 1,000 to 1,500 abdominal surgeries. The overall rate of retained surgical items is approximately 0.01% to 0.001% across procedures, with s accounting for 48% to 69% of such cases. These figures primarily reflect reported incidents, as gossypiboma predominantly arises in intra-abdominal contexts, comprising the majority of occurrences. Underreporting significantly distorts these estimates due to medicolegal fears among healthcare providers, leading to actual rates that are substantially higher—potentially by a factor of several times the documented numbers. In low-resource settings, the incidence can reach up to 1 in 1,000 surgeries, exacerbated by limited preventive measures and higher surgical volumes. Globally, studies indicate a decline in detection rates over recent decades despite ongoing prevention efforts, such as improved counting protocols. Demographically, gossypiboma is more prevalent among females, largely attributable to the frequency of cesarean sections and gynecological procedures. The majority of cases involve intra-abdominal retention, underscoring the procedure-specific vulnerability.

Risk Factors

Procedural factors significantly contribute to the risk of gossypiboma formation. surgeries are associated with a substantially elevated risk, with odds ratios ranging from 6- to 9-fold compared to elective procedures, primarily due to rushed preparations and incomplete sponge counts. Prolonged operations exceeding 4 hours further increase susceptibility by complicating inventory management and extending exposure to . Unplanned changes in procedure and involvement of multiple surgical teams exacerbate these issues, as they disrupt standardized counting protocols and heighten the chance of oversight. Patient-related characteristics also play a critical role in predisposing to retained surgical items. Morbid , often defined by a high (BMI >30), impairs surgical visibility and access, making it harder to account for all materials, with studies identifying it as an independent . Heavy intraoperative further complicates matters by diverting attention from counting and potentially displacing s within the operative field. Elevated BMI specifically hinders accurate sponge counts due to anatomical challenges in obese patients. Systemic elements within healthcare settings amplify procedural and patient risks. Surgeon fatigue, often stemming from extended shifts, correlates with diminished attention to detail during counts. Inadequate staffing and high patient turnover in busy centers contribute to errors, as frequent handovers increase miscommunication. Recent 2024 analyses indicate that 15–20% of gossypiboma cases are directly linked to team-related errors, such as staff changes mid-procedure. Overall, emergency cases account for 50–70% of reported incidents across series. There is no inherent gender bias in risk, though obstetric procedures show higher rates due to their emergent nature.

Pathophysiology

Mechanisms of Formation

Gossypiboma formation primarily arises from intraoperative failures in surgical accounting and placement, where s are inadvertently left within the patient's body during procedures. The most common mechanism involves discrepancies in counting protocols, such as miscounts during initial setup, interim checks, or final closure verification. In a seminal of 54 cases, 88% of retained foreign bodies—69% of which were s—occurred despite a final count being incorrectly reported as correct, highlighting the unreliability of manual counting under . These errors often stem from procedural lapses, including incomplete counts or to reconcile discrepancies before wound closure. Human factors exacerbate these procedural shortcomings, particularly in high-stress environments like emergency surgeries, which increase retention risk eightfold due to rushed protocols and omitted counts. Distractions from multiple team members, time constraints, or complex procedures can lead to overlooked sponges, while visual obstructions from blood, tissues, or equipment hinder thorough cavity exploration. For instance, in resource-limited settings, lack of standardized counting contributed to retention in 60% of reviewed intra-abdominal sponge cases, often tied to poor abdominal exposure during gynecological or emergency operations. Sponges are distinguished from other retained items like instruments by their absorbent nature and tendency to fragment or fold, making them harder to detect visually compared to rigid tools. Retention pathways typically involve the sponge being inadvertently placed or displaced into unintended anatomical spaces, such as behind organs or within pelvic recesses, during manipulation or retraction. As closure proceeds, s may fold into small crevices or migrate slightly due to organ repositioning, evading final sweeps. In 87% of analyzed retained incidents, such placements went undetected despite "correct" counts, often because teams over-relied on verbal confirmations without adjunct verification. These events occur almost exclusively within the surgical timeframe, with the sponge left behind by the end of the procedure—typically within the first 24 hours postoperatively—but remaining undetected until symptoms arise days to years later.

Host Responses

The host response to a retained surgical sponge, or gossypiboma, typically manifests in two distinct phases: an acute exudative reaction and a chronic aseptic fibrous reaction. In the acute phase, occurring within days to weeks post-surgery, the body initiates an exudative inflammatory response characterized by bacterial to the foreign , leading to and formation. This reaction involves rapid recruitment of neutrophils and macrophages, resulting in accumulation around the sponge and potential dissemination of pathogens. In contrast, the chronic phase develops over months to years when the initial is contained or absent, leading to an aseptic fibrous reaction where the sponge becomes encapsulated by dense fibrous tissue and form as a barrier to isolate the . This encapsulation can render the gossypiboma for extended periods, with cases reported remaining undetected for up to 24 years. development often includes central surrounded by epithelioid cells and peripheral , persisting as a walled-off mass. Key pathogenic processes underlying these responses include a giant cell reaction, where macrophages fuse into multinucleated s in an attempt to phagocytose the non-degradable sponge fibers, driven by interferon-gamma and Th1 cytokines. Additionally, pro-inflammatory cytokines such as tumor necrosis factor-alpha (TNF-α), interleukin-1 beta (IL-1β), IL-6, IL-8, and IL-12 are released by activated macrophages, amplifying local , fever, and tissue swelling. Radiopaque markers embedded in modern surgical sponges may contribute to localized by acting as additional foreign irritants, though their primary role is diagnostic. Location-specific variations influence the nature of the host response; intra-abdominal gossypibomas often provoke due to proximity to peritoneal surfaces and potential bacterial translocation from the . In thoracic cases, the response can lead to through pleural contamination and pus accumulation in the pleural space. Recent 2025 case reports highlight rare instances of chronic gossypibomas mimicking , such as low-grade sarcomas or gastrointestinal stromal tumors, due to granulomatous pseudotumor formation.

Clinical Manifestations

Symptoms and Presentation

Gossypiboma can manifest acutely within weeks of the initial surgery, typically presenting with symptoms such as fever, , , and , which often mimic an infectious process or . This early exudative reaction leads to a septic course, potentially resulting in or formation that exacerbates the acute distress. In contrast, chronic presentations emerge months to years after the procedure, featuring more insidious signs including a vague palpable abdominal , unexplained , and gastrointestinal disturbances like , , or . These delayed symptoms arise from a fibrinous response involving encapsulation and adhesions, which can cause mechanical issues such as partial obstruction without overt . The clinical picture varies by anatomical location; following cesarean section, gossypiboma may cause localized and abnormal , while intrathoracic cases often involve , , or . Many patients remain initially, with only about 6% of cases staying entirely without symptoms long-term, though incidental discovery during unrelated evaluations is common in such instances. Undetected gossypiboma frequently leads to diagnostic delays averaging 5–10 years, as the nonspecific nature of symptoms contributes to misdiagnosis as neoplasms or other chronic conditions like tumors. This prolonged latency underscores the challenge in recognizing the condition without targeted suspicion.

Complications

Untreated gossypiboma can lead to severe infectious complications, including , formation and rupture, and , which collectively contribute to significant morbidity and mortality. In acute cases, these infections arise from the inflammatory response to the retained , potentially disseminating bacteria throughout the . Mortality rates associated with such complications have been reported to range from 11% to 35%, depending on the duration of retention and patient comorbidities. Mechanical complications frequently involve gastrointestinal disruption, such as due to adhesions or direct compression by the mass, enterocutaneous formation, and organ erosion leading to intestinal . These sequelae often manifest months to years post-surgery, with the retained eroding into adjacent viscera and causing partial or complete obstruction. development, particularly enterocutaneous types, can result in chronic drainage and nutritional deficits. Additional complications include migration of the gossypiboma into adjacent structures like the or , often through transmural , which can mimic urinary or rectal . Rarely, the mass may present with imaging features resembling , leading to diagnostic delays. Studies indicate that approximately 69% of diagnosed cases necessitate reoperation for removal and management of these effects. Long-term consequences encompass chronic abdominal or from persistent and adhesions, as well as in cases involving the due to tubal obstruction or ovarian involvement. These chronic issues impose substantial healthcare burdens, with per-incident costs reaching up to $100,000 from extended hospitalizations, repeated imaging, and surgical interventions.

Diagnosis

Imaging Techniques

Plain radiography serves as the initial imaging modality for suspected gossypiboma, particularly useful when radiopaque markers are present within the retained sponge. These markers typically manifest as a "string of pearls" or wavy linear densities, representing the folded radiopaque threads embedded in the sponge. However, the sensitivity of plain radiographs is limited and variable, with reported intraoperative detection rates around 67% depending on the presence of markers and the location of the retained item, as many sponges lack such indicators or may be obscured by overlying structures. Computed tomography (CT) is the preferred imaging technique for detecting gossypiboma due to its high sensitivity, particularly for intra-abdominal cases. Characteristic findings include a spongiform or whorled mass with internal trapped gas bubbles, often appearing as a low-density heterogeneous with an enhancing capsule or peripheral calcification. The mass may exert , such as indented contours on adjacent organs like the bowel or liver. Magnetic resonance imaging (MRI) provides detailed soft-tissue characterization and is valuable when CT is inconclusive, especially for evaluating the extent of surrounding inflammation. On T2-weighted sequences, gossypiboma typically shows low signal intensity stripes or whorled patterns representing the folded gauze fibers within a high-signal inflammatory matrix. Ultrasound (US) is particularly effective for superficial or accessible locations, such as subcutaneous or pelvic sites, revealing an echogenic interface with posterior acoustic shadowing or a complex cystic mass with internal debris. Specific signs aid in differentiating gossypiboma from mimics like abscesses or tumors; for instance, the "fuzzy ball" appearance on CT describes the indistinct, mottled borders of the spongiform mass due to gas locules. Limitations arise with non-radiopaque sponges, which may present as nonspecific masses without distinctive features, reducing diagnostic confidence across modalities. Ongoing research explores applications in detecting retained surgical items on imaging, though specific advancements for CT in gossypiboma remain preliminary as of 2025.

Confirmatory Methods

Surgical exploration remains the gold standard for confirming gossypiboma, particularly through , which allows direct visualization and removal of the retained . During , the surgeon can identify the characteristic mass, often encapsulated by fibrous tissue or adhesions, enabling immediate retrieval and mitigating further complications. This method is especially reliable in cases where suggests an intra-abdominal mass, providing definitive verification upon incision. Endoscopy serves as a confirmatory technique for gossypibomas in accessible sites, such as those involving gastrointestinal migration, where the sponge may protrude into the lumen. Procedures like or can visualize the directly, facilitate if needed, and even allow for endoscopic retrieval in select cases, avoiding more invasive . For instance, in duodenal or colonic involvement, has confirmed the diagnosis in up to 73% of intraluminal cases through direct observation of the cotton matrix. Laboratory tests, including elevated (CRP) and (ESR), provide supportive evidence for gossypiboma by indicating ongoing , though these markers are nonspecific and cannot confirm the diagnosis alone. Levels of CRP may exceed 200 mg/L and ESR surpass 50 mm/h in some symptomatic cases, correlating with the , but normal results do not exclude the condition. These tests are typically used in conjunction with clinical history to heighten suspicion prior to more definitive methods. Histopathological examination of the excised mass offers final confirmation post-removal, revealing a granuloma characterized by multinucleated giant cells, macrophages, and embedded fibers within a fibrous capsule. Microscopic analysis identifies the nonabsorbable matrix surrounded by , distinguishing gossypiboma from other masses like tumors or abscesses. Recent multidisciplinary approaches, as outlined in 2023 case reporting guidelines, emphasize integrating with surgical and endoscopic findings for robust verification.

Management

Treatment Approaches

The management of diagnosed gossypiboma primarily involves a tailored approach based on the patient's clinical status, with conservative strategies reserved for select cases. For individuals, observation with serial imaging, such as computed tomography (CT) scans, is sometimes employed to monitor for progression, particularly when the retained is encapsulated without evidence of migration or complications. In instances of localized , antibiotics may be administered to control , as demonstrated in cases where [intravenous therapy](/page/intravenous therapy) led to symptomatic improvement over several weeks without immediate surgical intervention. However, conservative measures are generally limited due to the risk of delayed complications, and they are not suitable for all presentations. Intervention is indicated for symptomatic or complicated gossypiboma, including those causing obstruction, formation, or , where prompt removal is essential to mitigate risks. According to reviews of late-diagnosed cases, most necessitate intervention, aligning with consensus emphasizing surgical extraction to prevent further morbidity. A multidisciplinary team, comprising surgeons, radiologists for precise localization via imaging, and infectious disease specialists if needed, guides decision-making to optimize outcomes. Rarely, spontaneous expulsion occurs through a tract or via the gastrointestinal route, reported in about 4% of cases, potentially averting the need for intervention but often following transmural migration. With timely treatment, mortality can be significantly reduced, though delayed diagnosis elevates risks, with rates reported up to 35% in complicated cases. Associated costs, including payments and institutional expenses, average around $52,000 USD per case but can exceed $150,000 USD.

Surgical Interventions

Surgical interventions for gossypiboma primarily involve the removal of the retained surgical or , tailored to the , , and complications such as encapsulation or migration. The choice of approach depends on factors like and the patient's overall condition, with open remaining the most common method for intra-abdominal cases, often requiring adhesiolysis to free the from surrounding tissues. Laparotomy, the traditional open surgical approach, is utilized in approximately 70% of interventions for intra-abdominal gossypiboma, allowing direct visualization and for thorough exploration and removal. This method is particularly effective when extensive adhesions or abscesses are present, involving incision along previous surgical scars to minimize additional trauma, followed by meticulous and of the . In a series of 14 cases, facilitated successful removal in 10 patients, though it carries risks of prolonged recovery and wound complications compared to minimally invasive alternatives. Laparoscopy offers a minimally invasive option for gossypiboma in accessible locations, such as the without dense adhesions, by using small trocars for insertion of a camera and instruments to identify and extract the mass. This technique reduces postoperative pain, shortens hospital stays (often to 2-4 days), and improves cosmetic outcomes, with high success in uncomplicated cases where the sponge is encapsulated and not firmly adhered when performed by experienced surgeons. For instance, in reported cases, laparoscopic adhesiolysis and retrieval were completed with minimal blood loss and no conversions. Endoscopic retrieval is an emerging technique for gossypiboma that has migrated into hollow viscera, such as transgastric or duodenal locations, avoiding the need for in select patients. Using flexible , the sponge can be grasped and extracted through the , particularly effective for partially extruded foreign bodies, as demonstrated in cases of duodenal migration where successful removal resolved associated ulcers without . However, this approach is limited to smaller or superficially migrated items and may require adjunctive measures like piecemeal extraction. Recent reports from 2024 highlight successful endoscopic extractions in transgastric cases. Surgical challenges frequently include dense adhesions to adjacent organs, which can necessitate bowel resection in 10-30% of cases to address fistulas, perforations, or ischemia resulting from chronic inflammation. In one retrospective analysis, 28.6% of patients required segmental bowel resection or primary repair during removal due to such complications, underscoring the need for preoperative imaging to anticipate these issues. Postoperative care typically involves broad-spectrum antibiotics to prevent or treat , serial monitoring for , and follow-up imaging to confirm complete extraction, with most patients achieving uneventful recovery within weeks.

Prevention

Counting Protocols

The Association of periOperative Registered Nurses (AORN) establishes standardized counting protocols as a cornerstone for preventing gossypiboma and other retained surgical items during procedures. These guidelines mandate four counts per surgery: an initial count conducted before the procedure starts to establish a baseline inventory of items such as sponges, sharps, instruments, and miscellaneous supplies; a relief count performed whenever circulating or scrub personnel change to ensure continuity; a count before closure of body cavities or the surgical wound to verify all items are accounted for; and a final count at the procedure's conclusion. Each count involves the circulating registered nurse and the scrub person (nurse or surgical technologist), who jointly tally items aloud while visually inspecting the surgical field and drapes. The World Health Organization (WHO) integrates counting into its Surgical Safety Checklist, implemented globally since 2008 to enhance perioperative safety. The protocol emphasizes counting all accountable items at least twice—once before incision and again during sign-out before the patient leaves the operating room—while requiring clear verbal communication among team members to confirm results and resolve discrepancies. This approach is mandatory for high-risk surgeries, such as those involving body cavities, and has been linked to substantial reductions in retained item incidents, with institutional implementations demonstrating up to a 50% decrease in count errors through improved adherence. Documentation forms a critical component of these protocols to maintain accountability and facilitate audits. Results of each count must be recorded in written logs on the patient's intraoperative record, detailing the items counted (e.g., number of sponges, needles, and instruments), the personnel involved, and any discrepancies noted, with separate tallies for soft goods like sponges versus rigid items like instruments due to their differing propensities for retention. Verbal announcements of count outcomes to the entire surgical team, including the surgeon's acknowledgment, ensure immediate awareness and prompt reconciliation if needed. Effective implementation relies on robust for perioperative teams. Simulation-based , using mock operating room scenarios, allows staff to practice counting under realistic conditions, reinforcing protocols and addressing common like interruptions. The 2025 AORN updates further prioritize timeout pauses—standardized brief halts before incision and closure—to explicitly verify counts, promote interdisciplinary dialogue, and mitigate risks such as those from team changes.

Technological Innovations

Radiopaque markers have been integrated into surgical sponges since the late 1920s, with radiopaque threads introduced by Cahn in 1929 to enable visibility on , becoming a standard feature by the mid-20th century for detecting retained items intraoperatively or postoperatively. These markers, often woven as blue strands, provide dual functionality: radiographic detection via and visual identification in the surgical field, particularly when sponges are saturated with , as the blue color contrasts against tissue and fluids. Radiofrequency identification (RFID) systems emerged in the early 2000s as a real-time tracking solution, embedding passive RFID tags into s for automated counting and localization using handheld wands or mats placed under the patient. The U.S. (FDA) cleared the first RFID-based surgical counting system, ClearCount's SmartSponge, in 2007, followed by additional approvals in the 2010s, such as the ORLocate system in 2010, which demonstrated 99.8% accuracy in lab testing for detection. systems complement RFID by applying unique scannable labels to s, enabling computer-assisted counting that integrates with existing operating workflows to verify item accountability before wound closure. Clinical trials of -assisted counting showed improved detection of miscounts and misplaced s, with one randomized controlled study reporting prevention of at least 97.5% of potential retained s compared to manual methods alone. Intraoperative scanning technologies, including wand detectors and computed tomography (CT), further enhance localization during procedures. Handheld RFID wands, such as those in the Situate Detection System X, scan the surgical site in seconds to identify tagged sponges with near-perfect accuracy, alerting teams to discrepancies without . Intraoperative CT, while less common due to logistical demands, provides high-sensitivity imaging for complex cases, revealing retained sponges as hyperdense structures with associated artifacts, as demonstrated in clinical evaluations where it confirmed items missed by plain radiographs. By 2025, advancements in (AI)-integrated systems have introduced automated sponge localization, leveraging algorithms for computer-aided detection (CAD) on modalities. These AI models, such as artificial neural networks combined with radiopaque markers, analyze radiographs or intraoperative scans to flag potential retained sponges with enhanced accuracy, reducing false negatives in preliminary studies. Multimodal AI approaches, incorporating for real-time instrument and sponge tracking, further automate counting in dynamic operating environments, with one 2025 evaluation showing feasibility for preventing surgical never events through predictive alerts. Technological innovations in sponge counting, including RFID and systems, have demonstrated substantial effectiveness in reducing errors, with implementations across multiple hospitals achieving up to a 93% decrease in reported retained surgical sponges and approximately 80% reduction in time spent resolving unreconciled counts. RFID technology specifically correlated with 68% fewer near-miss incidents and unresolved miscounts in systematic reviews. However, these systems face limitations in settings, where rapid setup and high-volume procedures may hinder full integration, potentially relying more on manual adjuncts despite overall risk mitigation.

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