1530 | Same Session Transureteral Lithotripsy and Laparoscopy: A Case of Ureteral Stone with Abdominal Forgotten Gauze after Four Years Seyyed Habibollah Mousavi Bahar, Adel Eslami Corresponding Author: Adel Eslami, MD Urology and Nephrology Research Center, Hamedan University of Medi- cal Science, Hamedan, Iran. Tel: +98 9125153705 Fax: +98 8118237568 E-mail: adeleslami@yahoo.com Urology and Nephrology Research Center, Shaheed Beheshti Hospital, Hamedan University of Medical Sciences, Hamedan, Iran. VIDEO INTRODUCTION Forgotten‎or‎retained‎surgical‎gauze‎or‎pad‎in‎the‎abdominal‎or‎pelvic‎cavity‎after‎an‎operation‎is‎named‎gossypiboma.‎The‎other‎synonyms‎for‎gossypiboma‎are‎texti-loma,‎cottonoid,‎gauzoma‎and‎muslinoma.(1,2)‎Removal‎of‎surgical‎gauzes‎or‎instru- ments‎by‎laparoscopic‎surgery‎has‎already‎been‎done‎and‎reported.(3-7) Herein, we present a case‎of‎abdominal‎gossypiboma‎four‎years‎after‎hysterectomy.‎We‎performed‎laparoscopy‎as‎ the surgical option. Keywords:‎laparoscopy;‎methods;‎lithotripsy;‎ureteral‎calculi;‎surgery;‎treatment‎outcome;‎ abdomen;‎surgical‎sponge;‎foreign‎bodies. CASE REPORT A‎53-years-old‎woman‎presented‎with‎acute‎right‎renal‎colic.‎After‎medication‎and‎pain‎ mitigation,‎radiologic‎investigations‎were‎done.‎A‎10-mm‎stone‎in‎the‎right‎distal‎ureter‎ Video 1531Vol. 11 | No. 02 | March- April 2014 |U R O LO G Y J O U R N A L Same Session TUL and Laparoscopy | Mousavi Bahar et al and‎a‎forgotten‎surgical‎gauze‎in‎the‎left‎side‎of‎the‎pelvis‎ were‎observed‎on‎kidney-ureter-bladder‎(KUB)‎X-ray‎and‎ confirmed‎by‎intravenous‎urography‎(IVU)‎and‎computed‎ tomography‎ (CT)‎ scan.‎The‎ size‎ of‎ foreign‎ body‎ on‎ CT‎ scan‎was‎measured‎5‎×‎3.5‎cm‎which‎has‎been‎encircled‎by‎ the‎small‎intestine‎and‎the‎colon.‎Transureteral‎lithotripsy‎ (TUL)‎and‎Laparoscopy‎were‎scheduled.‎ SURGICAL TECHNIQUE Under‎general‎anesthesia‎and‎lithotomy‎position‎TUL‎was‎ performed‎and‎calculus‎particles‎were‎removed.‎There‎after‎ laparoscopy‎was‎settled‎in‎supine‎position‎with‎one‎12-mm‎ infra-umbilical‎port‎and‎two‎5-mm‎ports‎in‎the‎left‎and‎right‎ lower‎quadrants‎and‎the‎gauze‎was‎separated‎from‎the‎sur- rounding‎tissues‎and‎brought‎out‎from‎the‎abdomen‎by‎an‎ endo-catch‎bag.‎The‎patient‎was‎discharged‎on‎the‎fourth‎ postoperative‎day. DISCUSSION Forgetting‎or‎leaving‎gauzes‎or‎instruments‎in‎the‎body‎cav- ities‎after‎any‎operation‎is‎merely‎iatrogenic‎and‎considered‎ as‎ malpractice.(1,8,9)‎ Gawande‎ and‎ colleagues‎ studied‎ 61‎ patients.‎They‎reported‎the‎presence‎of‎surgical‎sponge‎in‎ 69%‎of‎cases.(10)‎Rodrigues and colleagues described a case of‎intra-abdominal‎forgotten‎ribbon‎malleable‎retractor‎(33‎ ×‎5‎cm)‎since‎14‎years‎ago.‎ The‎incidence‎of‎gossypiboma‎was‎estimated‎from‎1:8801‎ to‎1:18760‎of‎surgeries‎by‎and‎colleagues.(10)‎Several‎risk‎ factors‎have‎been‎reported‎for‎leaving‎sponge‎and‎instru- ments‎in‎operation‎field,‎including‎an‎emergency‎operation‎ and‎long‎duration‎of‎operation.(2,10,11)‎Some‎gossypibomas‎ are‎symptomatic‎and‎the‎others‎are‎asymptomatic.(3) In any case‎,‎it‎is‎recommended‎to‎be‎removed‎surgically‎or‎lapa- roscopically.(11)‎ A‎case‎of‎ laparoscopic‎diagnosis‎and‎removal‎of‎sponge‎ 14‎days‎after‎surgery‎was‎reported‎also‎by‎Singh‎and‎col- leagues,(3)‎ in‎ the‎ meanwhile‎ Olivier‎ and‎ Devriendt‎ de- scribed‎a‎case‎of‎laparoscopic‎removal‎of‎a‎gauze‎which‎ had‎been‎forgotten‎in‎the‎abdomen‎of‎a‎patient‎as‎long‎as‎ 22 years.(5) Our‎case,‎presented‎with‎renal‎colic‎and‎the‎retained‎gauze‎ in‎her‎abdomen‎was‎detected‎accidentally.‎After‎radiologic‎ studies,‎we‎removed‎the‎ureteral‎stone‎and‎forgotten‎gauze‎ in‎the‎same‎session‎anesthesia,‎and‎accomplished‎both‎sur- geries endoscopically. CONCLUSION According‎ to‎ our‎ experience‎ and‎ other‎ reports,‎ it‎ seems‎ laparoscopic‎surgery‎can‎be‎appropriate‎option‎for‎removal‎ of‎forgotten‎pads‎or‎instruments,‎and‎can‎be‎performed‎in‎ early or delayed diagnosed cases. CONFLICT OF INTEREST None declared. REFERENCES 1. Cheng TC, Chou AS, Jeng CM, Chang PY, Lee CC. Computed tomog- raphy findings of gossypiboma. J Chin Med Assoc. 2007;70:565-9. 2. Bani-Hani KE, Gharaibeh KA, Yaghan RJ. Retained surgical sponges (gossypiboma). Asian J Surg. 2005;28:109-15. 3. Singh R, Mathur RK, Patidar S, Tapkire R. Gossypiboma: its laparo- scopic diagnosis and removal. Surg Laparosc Endosc Percutan Tech. 2004;14:304-5. 4. Sharifiaghdas F, Mohammad Ali Beigi F, Abdi H. Laparoscopic re- moval of a migrated intrauterine device. Urol J. 2007;4:177-9. 5. Olivier F, Devriendt D. Laparoscopic removal of a chronically re- tained gauze. Acta Chir Belg. 2003;103:108-9. 6. Rodrigues D, Perez NE, Hammer PM, Webber JD. Laparoscopic re- moval of a retained intra-abdominal ribbon malleable retractor af- ter 14 years. J Laparoendosc Adv Surg Tech A. 2006;16:369-71. 7. Ibrahim IM. Retained surgical sponge. Surg Endosc. 1995;9:709-10. 8. Sharma D, Pratap A, Tandon A, Shukla RC, Shukla VK. Uncon- sidered cause of bowel obstruction-- gossypiboma. Can J Surg. 2008;51:E34-5. 9. Szentmariay IF, Laszik A, Sotonyi P. Sudden suffocation by surgical sponge retained after a 23-year-old thoracic surgery. Am J Forensic Med Pathol. 2004;25:324-6. 10. Gawande AA, Studdert DM, Orav EJ, Brennan TA, Zinner MJ. Risk factors for retained instruments and sponges after surgery. N Engl J Med. 2003;348:229-35. 11. Erdil A, Kilciler G, Ates Y, et al. Transgastric migration of retained in- traabdominal surgical sponge: gossypiboma in the bulbus. Intern Med. 2008;47:613-5.