title: Laparoscopic accessory splenectomy with intraoperative gamma probe localization for recurrent idiopathic thrombocytopenic purpura.
abstract: Laparoscopic excision of retained splenic tissue has been described as a treatment of recurrent hematologic disease after formal splenectomy. It is associated with a shorter hospital stay, more rapid recovery, and lower or equivalent morbidity compared with open surgery. However, intraoperative identification of residual splenic tissue remains difficult, particularly when preoperative computed tomography or magnetic resonance imaging results are unremarkable. It has been suggested that the laparoscopic approach has a lower success rate due to the loss of tactile feedback. We report a case of successful laparoscopic excision of retained splenic tissue using technetium sulfur colloid injection and intraoperative gamma probe localization in a patient with recurrent idiopathic thrombocytopenic purpura, 12 years after open splenectomy. This represents the first report of this intraoperative adjunctive measure for the laparoscopic identification and excision of functional accessory splenic tissue.
authors.affiliation: Department of General Surgery, Naval Medical Center San Diego, California 92134, USA.
authors.forename: Jared
authors.initials: J
authors.lastname: Antevil
authors.forename: David
authors.initials: D
authors.lastname: Thoman
authors.forename: Janos
authors.initials: J
authors.lastname: Taller
authors.forename: Michael
authors.initials: M
authors.lastname: Biondi
mesh_terms: D005260:Female; D006801:Humans; D007430:Intraoperative Care / Q000379:methods*; D010535:Laparoscopy / Q000379:methods*; D008875:Middle Aged; D016553:Purpura, Thrombocytopenic, Idiopathic / Q000000981:diagnostic imaging* / Q000601:surgery*; D011877:Radionuclide Imaging; D019275:Radiopharmaceuticals; D012008:Recurrence; D013154:Spleen / Q000000981:diagnostic imaging* / Q000601:surgery*; D013156:Splenectomy / Q000379:methods*; D013671:Technetium Tc 99m Sulfur Colloid
chemical_list: D019275:Radiopharmaceuticals; D013671:Technetium Tc 99m Sulfur Colloid