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Abstract
Introduction/Background When a recurrent ovarian or endometrial cancer appears to be limited to a solitary site, or when a patient with ovarian remnant is referred for prophylactic surgery, a laparoscopic approach may be feasible. However, small lesions often represent a challenge for surgical management, even more if accompained by adhesions. Radio-guided surgery has been demonstrated to be a reliable approach in localizing lesions in other specialties, such as pulmonary surgery. It can also be useful in laparoscopic surgery. We describe the case of two patients, with good correlation between CT or endoscopic ultrasound marking and the surgical site.
Methodology 1mCi Technetium-99m-macroaggregated albumin (Tc-99m-MAA) in 0.2 mL sterile saline was injected intralesionally, through 18-gauge needle CT-guided in the first case and through 22-gauge needle guided by transrectal endoscopic ultrasound in the second case. SPECT-CT images centered on the pelvic area were acquired 3 hours later (GE discovery gamma-camera; LEHR collimator; Energy-peak 140 KeV; 128x 128 matrix). The images confirmed the concentration of the radiopharmaceutical at the point of administration and the absence of dispersion to other locations.
The next day, during the laparoscopic surgery, a 10 mm diameter probe (Navigator GPS gamma probe) was introduced by a 12 mm trocar and used to determine the location of the lesion.
Results Both patients had previously undergone laparoscopy with failed outcome (inability to identify the tissue to be removed), and both were subsequently successful in a second laparoscopy using the described technique.
Conclusion Radio-guided surgery using Tc-99m-MAA is a feasible approach useful for intraoperative localization of lesions via laparoscopy. It can be injected guided by CT or endoscopic ultrasound depending on the anatomical location. It has a low radiological burden for personnel exposure and low morbidity. The lack of necessity to conduct radio-guided surgery under fluoroscopy makes this radio-guided surgery an easy way of performing precise surgical procedures.
Disclosures The authors declare no conflicts of interest.
