Retained surgical items (RSIs) are significant but highly preventable errors. Manual counting procedures have been the standard of care for surgical counts for many years. However, despite strict counting protocols, surgical items are still inadvertently left inside patients after wound closure. These retained surgical items are a potential source of morbidity for patients and a liability for care providers and healthcare facilities. They also are associated with important economic implications in the face of changing reimbursement. The numerous variables that must be considered during the surgical count process have made errors related to RSI all too prevalent. Today, adjunct technologies have been developed to provide a better way to improve the accuracy of manual surgical counts, adding another level of safety, and thus promoting positive outcomes.