in our gyne. procedures, the circulator usually does the prep. We have a prep set that we use, that comes with five prep sponges. It is not part of the set up, the scrub nurse does not count them with her other sponges. However, for a pt. who has had a previous hyster, the surgeon inserts a sponge on a stick to manipulte internally when performing a laperoscopy. The count done at skin, includes the one "inside". Once removed, the scrub will show the circulator the removed sponge. When I first did this procedure, as the scrub. I was used to having to remove the tenac, and sound for the surgeon. I went to gently undo what I thought was the tenac, when the surgeon told me, that it was a sponge stick, with sponge on. I was new, and never knew what is now obvious to me, there is nothing for the tenac to grab with a lady who has had a hyster!! I hadn't even seen him insert the sponge on a stick!! I learned something that day. It frightened me to think I may have left it inside.