Intraoperative surgical needle loss in robotic-assisted and laparoscopic surgery: a systematic review and practical troubleshooting framework.

Intraoperative loss of a surgical needle during minimally invasive surgery (MIS) is uncommon but clinically important. In robotic-assisted surgery (RAS), altered sensory conditions and evolving trocar designs may influence both needle-loss mechanisms and retrieval strategy. We systematically reviewed the literature and developed a practical troubleshooting framework. PubMed, Embase, CNKI, and Wanfang were searched from inception to January 2026 in accordance with PRISMA 2020. Studies reporting intraoperative needle loss during abdominal or pelvic MIS or RAS were included. Because of substantial heterogeneity, findings were synthesized narratively. Thirty-three studies were included, comprising 27 original studies and 6 narrative reviews. Quantitative outcome aggregation was restricted to clinical patient-level studies, yielding 37 extractable lost-needle events: 22 during RAS and 15 during conventional laparoscopy. Minimally invasive retrieval was successful in 35/37 cases, whereas incision extension or open conversion was required in 2/37. Recurrent practical risk scenarios included trocar-pathway entrapment, including the hypothesized "Trocar Trap," and possible risk amplification related to absent haptic feedback in RAS. Evidence supporting adjunctive localization tools, including fluoroscopy and magnetic assistance, remained limited and largely non-comparative. Needle loss in contemporary MIS and RAS should be regarded as a workflow-sensitive patient safety event supported mainly by low-level evidence. The most relevant contemporary implications concern robotic workflow, port-pathway inspection, disciplined handoff, and selective use of adjunctive retrieval tools within a stepwise troubleshooting framework. Registration: PROSPERO (CRD420261294460).