Intraoperative Gamma probe localization and laparoscopic accessory

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Intraoperative Gamma probe localization and laparoscopic accessory Powered By Docstoc
					1006 Endo+Colon Poster INTRAOPERATIVE GAMMA PROBE LOCALIZATION AND LAPAROSCOPIC ACCESSORY SPLENECTOMY L. Lantsberg1, S. Lantsberg2, B. Kirshtein1, L. Hatskelson3, E. Avinoach1 Department of Surgery A1, Nuclear Medicine2 and Hematology Institutes3 Soroka University Medical Center, Ben Gurion University of the Negev, Beer Sheva Israel Idiopathic thrombocytopenic purpura (ITP) is one of the most common hematological diseases with an estimated prevalence of 5 in 10000. Splenectomy is advised in adult patients with refractory ITP or in patients who fail to medical treatment or who present with active bleeding. In recent years laparoscopic splenectomy has become the treatment of choice, since it combines lower morbidity, reduced in hospital stay with good clinical results. The success of laparoscopic splenectomy depends on intact retrieval of the spleen with the aid of impermeable bag and the avoidance of missing accessory splenic tissue. In cases of accessory splenic tissue in postsplenectomy patients it is almost importance to localize the accessory spleen prior to surgery. Several studies have showed the feasibility of laparoscopic resection of accessory splenic tissue using preoperative scintigraphy. We report two postsplenectomy patients of an accessory spleen causing relapsing ITP. Accessory spleens were diagnosed and localized preoperatively by positive uptake at heat-damaged Tc99m-labeled RBC scintigraphy. The patients underwent hand-held Gamma probe assisted laparoscopic accessory splenectomy. Recurrence ITP was not observed during 24 months follow-up. Conclusions: The use of intraoperative nuclear imaging can greatly aid the localization and provide confirmation of complete laparoscopic excision of the nuclear focus especially for a very small accessory spleen avoiding a major open procedure, and good postoperative results could be obtained.