Abstract
Background
Preoperative determination of the accessory spleen still is a major factor in the failure of both laparoscopic and conventional techniques. This study aimed to evaluate the practicability and efficacy of a handheld gamma probe in identifying accessory spleens at the initial intervention.
Methods
This study evaluated 17 patients undergoing laparoscopic splenectomy attributable to benign hematologic disorders. All the patients had preoperative ultrasonography, computed tomography (CT) scan, and nuclear scintigraphic examination of the abdominal cavity to assess the size of the spleen, and to determine the existence of the accessory spleen or spleens. For all the patients, a handheld gamma probe count was used intraoperatively as an adjuvant method to define the presence and location of the accessory splenic tissue. Control nuclear scintigraphic examinations of all the patients were performed 1 month after the surgical procedure.
Results
In two cases, intraoperatively accessory splenic tissue was detected by gamma probe, confirming the preoperative CT findings for the patients. One of these patients had three accessory spleens, although preoperative CT scan showed only two of them. However, by the help of the gamma probe, a third spleen located retroperitoneally was defined. For two patients, laparoscopic exploration and handheld gamma probe count did not identify any accessory splenic tissue, although preoperative CT scan indicated accessory spleens. For detecting accessory splenic tissue, the sensitivities of the studied techniques were 0% for ultrasonography, 75% for CT scan, 0% for preoperative nuclear scintigraphy, 75% for laparoscopic exploration, and 100% for perioperative gamma probe examination.
Conclusion
Preoperative imaging methods for accessory spleen determination still have limited benefits because of their limited sensitivity. Thus, the handheld gamma probe technique may be an adjuvant method for laparoscopic exploration ensuring that no accessory splenic tissue is missed during the initial surgical treatment of benign hematologic disorders.
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References
Akwari OE, Itani KM, Coleman RE, Rosse WF (1987) Splenectomy for primary and recurrent immune thrombocytopenic purpura (ITP): current criteria for patient selection and results. Ann Surg 206: 529–541
Antevil J, Thoman D, Taller J, Biondi M (2002) Laparoscopic accessory splenectomy with intraoperative gamma probe localization for recurrent idiopathic thrombocytopenic purpura. Surg Laparosc Endosc Percutan Tech 12: 371–374
Balague C, Targarona EM, Cerdan G, Novell J, Montero O, Bendahan G, Garcia A, Pey A, Vela S, Diaz M, Trias M (2004) Long-term outcome after laparoscopic splenectomy related to hematologic diagnosis. Surg Endosc 18: 1283–1287
Chowbey PK, Goel A, Panse R, Sharma A, Khullar R, Soni V, Baijal M (2005) Laparoscopic splenectomy for hematologic disorders: experience with the first fifty patients. J Laparoendosc Adv Surg Tech A 15: 28–32
Chung CW, Lee WJ, Choi JS, Ko YW, Han JS, Min YH, Kim BR (1999) Laparoscopic splenectomy for immune thrombocytopenic purpura: long-term result of 40 laparoscopic splenectomies. Yonsei Med J 40: 578–582
Delaitre B, Maignien B (1991) Splenectomy by the laparoscopic approach: report of a case. Presse Med 20: 2263
Finkelde DT, Hicks RJ, Wolf M, Henderson MA (2000) Handheld gamma probe localization of accessory splenic tissue in recurrent idiopathic thrombocytopenic purpura. Arch Surg 135: 1112–1113
Gigot JF, Jamar F, Ferrant A, van Beers BE, Lengele B, Pauwels S, Pringot J,Kestens PJ, Gianello P, Detry R (1998) Inadequate detection of accessory spleens and splenosis with laparoscopic<splenectomy: a shortcoming of the laparoscopic approach in hematologic diseases. Surg Endosc 12: 101–106
Mercan S, Seven R, Erbil Y (1996) Laparoscopic treatment of accessory splenic tissue. Surg Laparosc Endosc 6: 330–331
Meyer G, Wichmann MW, Rau HG, Hiller E, Schildberg FW (1998) Laparoscopic splenectomy for idiopathic thrombocytopenic purpura: a 1-year follow-up study. Surg Endosc 12: 1348–1352
Napoli A, Catalano C, Silecchia G, Fabiano P, Fraioli F, Pediconi F, Venditti F, Basso N, Passariello R (2004) Laparoscopic splenectomy: multi-detector row CT for preoperative evaluation. Radiology 232: 361–367
Park A, Targarona EM, Trias M (2001) Laparoscopic surgery of the spleen: state of the art (review). Langenbecks Arch Surg 386: 230–239
Pohlson EC, Wilkinson RW, Witzum KF, Coel MN (1994) Heat-damaged red cell scan for intraoperative localization of the accessory spleen. J Pediatr Surg 29: 604–608
Rogers J, Yousuf A, Kleinhaus S (1997) Laparoscopic accessory splenectomy in recurrent chronic immune thrombocytopenic purpura. Surg Laparosc Endosc 7: 83–85
Rudowski WJ (1985) Accessory spleens: clinical significance with particular reference to the recurrence of idiopathic thrombocytopenic purpura. World J Surg 9: 422–430
Wu JM, Lai IR, Yuan RH, Yu SC (2004) Laparoscopic splenectomy for idiopathic thrombocytopenic purpura. Am J Surg 187: 720–723
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Barbaros, U., Dinççağ, A., Erbil, Y. et al. Handheld gamma probe used to detect accessory spleens during initial laparoscopic splenectomies. Surg Endosc 21, 115–119 (2007). https://doi.org/10.1007/s00464-006-0001-z
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DOI: https://doi.org/10.1007/s00464-006-0001-z