Ho-Seong Han, Jai Young Cho, YoungRok Choi, Seong Uk Kwon, Jae Seong Jang, Sungho Kim. Seoul National University Bundang Hospital
Background: Laparoscopic surgery for gallbladder cancer (GBC) has been contraindicated for a long time. Recently there have been a few reports on laparoscopic extended cholecystectomy for GBC, but most of indications are early GBC confined to the GB. This video describes our technique of laparoscopic extended cholecystectomy for T3 GBC.
Method: A 76-year-old female presented with a gallbladder mass incidentally detected during evaluation for back pain. Abdominal CT and endoscopic ultrasonography revealed a 3.5 x 2.5 cm sized hypoechoic mass located in the gallbladder fundus with liver invasion. Laparoscopic en bloc resection of the gallbladder, the gallbladder bed, and lymphadenectomy was performed.
Results: Two 5-mm and three 12-mm trocars were used. After careful dissection of Calot’s triangle, the cystic duct was dissected and ligated. The cystic duct margin was negative on the frozen section biopsy. A cholecystectomy with en bloc wedge resection of the liver was performed, using the ultrasonic shear for transection of superficial hepatic parenchyma and the Cavitron Ultrasonic Surgical Aspirator (CUSA) for transection of deeper portion of the parenchyma. Lymphadenectomy involved lymph nodes (LNs) around the hepatoduodenal ligament and common hepatic artery, and posterior superior pancreas. After kocherization of the duodenum, LNs were dissected from the posterior superior portion of the pancreas. LN dissection continued along the right side of the common bile duct and the portal vein. After further dissection from the IVC and the aorta, dissected LNs were pushed toward the left side under the portal vein. In the left side of the hepatoduodenal ligament, LN dissection continued, exposing the common hepatic artery and proper hepatic artery. Finally, skeletonizing en bloc LN dissection could be performed. The operative time was 215 minutes, and the estimated intraoperative blood loss was 200 mL. The postoperative pathology confirmed a small cell neuroendocrine carcinoma with clear resection margins. The pathologic staging was pT3N1. Lymph node metastasis was present in out of 12 retrieved lymph nodes. The patient was discharged on postoperative day 4 without postoperative complications.
Conclusion: Laparoscopic extended cholecystectomy for T3 GBC is technically feasible with the same extent of surgical resection as open surgery.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 80118
Program Number: V126
Presentation Session: Biliary Video Session
Presentation Type: Video