Abstract
BACKGROUND: Valveless trocars like AirSeal system are maintain a stable pneumoperitoneum and reduce instrument friction. CASE PRESENTATION: A 65-year-old man's robotic radical cystectomy was complicated by a missing needle while using AirSeal system. The needle was detected via backward inspection using the endo camera inserted through the trocar, tip at its most distal end let the visualization of the needle within the air channels and confirmed with a trocar X-ray. CONCLUSION: Our findings suggest that retrograde inspection and targeted radiography of the trocar, prior to patient imaging, can be helpful in locating the lost needle and prevent prolongation of surgeries.