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Radioguided Adrenal Surgery: Access in Complex Situations: Technical Notes.

Javier Deus¹, Alfonso Millera, Alejandro Andrés

¹From the Department of Surgery, University Hospital, Zaragoza, Spain (JD, AM, IG, MS); Department of Nuclear Medicine, University Hospital, Zaragoza, Spain (AA, EP); Department of Podiatry, University of Sevilla, Spain (JLS); and Department of Human Anatomy and Histology, University of Zaragoza, Spain (ML).

|October 2, 2015

Summary

Laparoscopic adrenalectomy is challenging in patients with prior surgery or obesity. A portable gamma probe aided gland localization and excision in two complex cases, ensuring complete tumor removal.

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Area of Science:

Surgical Oncology
Minimally Invasive Surgery
Endocrinology

Background:

Laparoscopic adrenalectomy is the preferred method for adrenal gland tumors and hyperplasia.
Challenges arise in specific patient populations, including those with prior abdominal surgeries and severe obesity, complicating gland localization and tumor excision.
Accurate identification and complete removal of adrenal lesions are critical for successful treatment outcomes.

Observation:

Two cases of left adrenal tumors presented unique surgical challenges due to patient history.
The first patient had a history of extensive intra-abdominal surgery, causing anatomical distortion.
The second patient had severe obesity, increasing surgical difficulty and potentially obscuring the adrenal gland.

Findings:

The intraoperative use of a portable gamma probe was instrumental in overcoming localization difficulties in both patients.
The gamma probe facilitated precise identification of the left adrenal gland, even in the presence of adhesions from previous surgery.
Complete excision of the adrenal tumors was achieved in both cases without delay, attributed to the gamma probe's guidance.

Implications:

The gamma probe is a valuable tool for enhancing the safety and efficacy of laparoscopic adrenalectomy in complex cases.
This technology can potentially expand the applicability of minimally invasive approaches for adrenal tumors in challenging patient profiles.
Successful application suggests improved patient outcomes and reduced operative times in difficult adrenalectomies.