A comprehensive overview of radioguided surgery using gamma detection probe technology

The concept of radioguided surgery, which was first developed some 60 years ago, involves the use of a radiation detection probe system for the intraoperative detection of radionuclides. The use of gamma detection probe technology in radioguided surgery has tremendously expanded and has evolved into what is now considered an established discipline within the practice of surgery, revolutionizing the surgical management of many malignancies, including breast cancer, melanoma, and colorectal cancer, as well as the surgical management of parathyroid disease. The impact of radioguided surgery on the surgical management of cancer patients includes providing vital and real-time information to the surgeon regarding the location and extent of disease, as well as regarding the assessment of surgical resection margins. Additionally, it has allowed the surgeon to minimize the surgical invasiveness of many diagnostic and therapeutic procedures, while still maintaining maximum benefit to the cancer patient. In the current review, we have attempted to comprehensively evaluate the history, technical aspects, and clinical applications of radioguided surgery using gamma detection probe technology

Vascular and biliary variants in the liver: Implications for liver surgery

Accurate preoperative assessment of the hepatic vascular and biliary anatomy is essential to ensure safe and successful hepatic surgery. Such surgical procedures range from the more complex, like tumor resection and partial hepatectomy for living donor liver transplantation, to others performed more routinely, like laparoscopic cholecystectomy. Modern noninvasive diagnostic imaging techniques, such as multidetector computed tomography (CT) and magnetic resonance (MR) imaging performed with liver-specific contrast agents with biliary excretion, have replaced conventional angiography and endoscopic cholangiography for evaluation of the hepatic vascular and biliary anatomy. These techniques help determine the best hepatectomy plane and help identify patients in whom additional surgical steps will be required. Preoperative knowledge of hepatic vascular and biliary anatomic variants is mandatory for surgical planning and to help reduce postoperative complications. Multidetector CT and MR imaging, with the added value of allow accurate identification of areas at risk for image postprocessing, venous congestion or devascularization. This information may influence surgical planning with regard to the extent of hepatic resection or the need for vascular reconstruction. (c) RSNA, 2008