A 32-year-old male patient showed 2 focal uptakes of I-MIBG next to the left renal vein in a diagnostic scan, corresponding to paragangliomas. An operation was indicated, and to guide resection during surgery we used the freehand SPECT system. In the operating room, using freehand SPECT, both lesions were found. The system was of additional value in planning the operative access to the region of interest and in determining the depth of 1 lesion for precise and more rapid extirpation. Furthermore, it confirmed no residues in the operating field after resection of the tumors.