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ObjectiveTo evaluate the efficacy of intraoperative ultrasound in obtaining adequate surgical margins in women undergoing lumpectomy for palpable breast cancer. Summary Background DataAdequacy of surgical margins is a subject of debate in the literature for women undergoing breast-conserving therapy. The emerging technology of intraoperative ultrasound-guided surgery lends itself well to a prospective study evaluating surgical accuracy and margin status after lumpectomy. MethodsTwo groups of women undergoing lumpectomy for palpable breast cancer were studied, one group using intraoperative ultrasound (n ϭ 27) and the other without (n ϭ 24). Pathologic specimens were evaluated for size, margins, and accuracy, and patients were questioned about satisfaction with cosmetic results. ResultsSurgical accuracy was improved with intraoperative ultrasound-guided surgery. Margin status was improved, patient satisfaction was equivalent, and cost was not affected using ultrasound technology. Intraoperative ultrasound appears especially efficacious for women whose preoperative mammogram shows dense parenchyma surrounding the lesion. ConclusionsThe use of ultrasound-guided surgery optimizes the surgeon's ability to obtain satisfactory margins for breast-conserving techniques in patients with breast cancer. Patient satisfaction is excellent and a cost savings is most likely realized.Although A-mode or non-real-time B-mode ultrasound imaging started in the 1960s, it was of limited clinical utility. With the introduction of high-frequency real-time B-mode ultrasound in the late 1970s, the surgeon could use ultrasound to guide surgical procedures. Special intraoperative probes were developed, and in the 1980s intraoperative ultrasound (IOUS) was developed for hepatobiliary surgery, neurosurgery, and vascular surgery.1 Breast surgeons were quick to begin using office-based ultrasound for defining breast lesions and guiding needle biopsy of ultrasound-visible lesions, but the transfer of this technology to the surgical suite for breast procedures has been a recent phenomenon.Breast-conserving therapy (BCT) has gained wide acceptance as providing long-term survival equal to that seen with mastectomy for early-stage breast cancers, and accordingly the number of lumpectomy procedures has increased dramatically. Too often, however, the surgeon is disappointed to discover that a lumpectomy performed for a small palpable tumor fails to achieve a complete excision with histopathologically negative margins. The patient may then undergo a second resection with the goal of obtaining clear pathologic margins. This recommendation for reexcision often occurs even as conflicting data are published about the need for such margins to be completely free of malignancy.

Adrenal-mediated hypertension (AMH) has been increasingly treated by laparoscopic adrenalectomy (LA). Metabolic derangements in patients with AMH could result in perioperative complications and mortality. Long-term operative and clinical outcomes after laparoscopic treatment of AMH have not been evaluated using large clinical databases. The institutional National Surgical Quality Improvement Program (NSQIP) data for patients undergoing adrenalectomy for AMH between 2002 and 2012 were reviewed. Patient demographics, perioperative variables, and outcomes were analyzed and compared with national NSQIP adrenalectomy data. Improvement in AMH was recorded when discontinuation or reduction of antihypertensive medication occurred or with a decrease of blood pressure on the preoperative antihypertensive regimen. Ninety-four patients underwent adrenalectomy. There were 48 patients with pheochromocytoma (PHE) and 46 patients with aldosterone-producing adenoma (APA). Eighty-five patients (90%) were taking antihypertensive medications preoperatively compared with 36 patients (38%) post-operatively ( P < 0.0001). Patients with PHE were more likely to discontinue all medications compared with the patients with APA (80 vs 20%, respectively, P < 0.0001). Patients with PHE and APA, respectively, took an average of 2.0 and 3.2 antihypertensive medications preoperatively compared with 0.3 and 1.2 postoperatively. There were no conversions to open procedures or 30-day mortality. Our results were 0 per cent for cerebral vascular accident, 0 per cent for myocardial infarction, and 0.5 per cent for transfusions compared with the national NSQIP data of 0.2, 0, and 6.7 per cent, respectively. Patients presenting with significant AMH including PHE and APA can be effectively and safely treated with LA with minimal complications and with a significant number of patients eliminating or decreasing their need for antihypertensive medications.

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