title: Handheld gamma probe used to detect accessory spleens during initial laparoscopic splenectomies.
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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of General Surgery, Istanbul University, Istanbul Medical School, Capa, 34390, Istanbul, Turkey. umutbarbaros@yahoo.com
authors.forename: Umut
authors.initials: U
authors.lastname: Barbaros
authors.forename: Ahmet
authors.initials: A
authors.lastname: Dinççağ
authors.forename: Yesim
authors.initials: Y
authors.lastname: Erbil
authors.forename: Selcuk
authors.initials: S
authors.lastname: Mercan
authors.forename: Yasemin
authors.initials: Y
authors.lastname: Sanli
authors.forename: Işik
authors.initials: I
authors.lastname: Adalet
authors.forename: Reyhan
authors.initials: R
authors.lastname: Küçükkaya
mesh_terms: D000328:Adult; D000368:Aged; D000013:Congenital Abnormalities / Q000175:diagnosis; D003949:Diagnostic Techniques, Surgical / Q000295:instrumentation*; D004867:Equipment Design; D005260:Female; D005720:Gamma Rays; D006402:Hematologic Diseases / Q000601:surgery*; D006801:Humans; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D012680:Sensitivity and Specificity; D013154:Spleen / Q000002:abnormalities* / Q000601:surgery*; D013156:Splenectomy; D014057:Tomography, X-Ray Computed; D014463:Ultrasonography