Thanks for your replies. We do currently count liga clips, staple cartridges, esu tips etc but seem to have more opposition on counting raney clips. If one becomes dislodged during the procedure and fell in the wound, dont you think it would be seen? It will be a hassle to change surgeon behavior to count them and to not let these things fly off the wound! The practice of using an xray to confirm every count is a scary one! Not all things are seen on xray, especially small needles. I have also seen a radiologist pick up a foreign body on an xray that had been read as negative by the surgeon.