Handheld gamma probe used to detect accessory spleens during initial laparoscopic splenectomies

Abstract

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.

Computed tomography to detect accessory spleens before laparoscopic splenectomy: is it necessary?

“…Therefore, the handheld gamma probe may have a role to play after splenectomy. Barbaros et al found the gamma probe to be more sensitive than CT scan in detecting AcS (100% vs. 75%); in their series, two AcS detected on preoperative CT findings could not be confirmed during exploration with gamma probe [15]. This finding is similar to ours in that two patients with AcS who were identified on preoperative CT scan were not found upon laparoscopic exploration, and further postoperative imaging did not confirm any persistent splenic tissue.…”

“…Some advocate the use of a handheld gamma probe to aid intraoperative localization of AcS [15], although this has not gained popularity. However, the main disadvantage of nuclear scintigraphy is its inability to detect AcS when normal spleen exists due to most of the nuclear markers being absorbed by normal splenic tissue.…”

Laparoscopic splenectomy: the clinical practice guidelines of the European Association for Endoscopic Surgery (EAES)

“…Recently, Barbaros et al [37] reported the use of a handheld gamma probe for intraoperative detection of accessory spleens during initial surgery and compared the results with preoperative CT and intraoperative findings (LoE 4) [37]. They found that the handheld gamma probe had a sensitivity of 100% for detecting accessory spleens in 2 of 17 patients, one of which had not been detected previously by CT.…”

“…This may be in the form of accessory spleens missed during the initial surgery or splenic implants that have developed as splenosis after splenic capsule injury and cell spillage during surgery. If remaining splenic tissue is detected, laparoscopic removal is a safe and feasible technique (LoE 4) [16,32,37,47]. The choice of approach (i.e., lateral or semilateral) may be made according to the location of the accessory spleen or spleens.…”

The use of a handheld gamma probe for identifying two accessory spleens in difficult locations in the same patient

“…A diligent and thorough search for accessory spleens is possible and mandatory with laparoscopic splenectomy, and this modality results in the same rate of accessory spleen removal as open splenectomy [2]. Laparoscopy allows the exploration of the splenic hilum, tail of the pancreas, splenocolonic and gastrosplenic ligaments, and greater omentum; however, accessory spleen may hide in more diffi cult although rare locations.…”