C Palanivelu, MS, MCh, FRCS, P Senthilnathan, MS, FACS, R Parthasarathi, MS, P Praveen Raj, MS, R Sathiyamurthy, MS, V P Nallankilli, MS. GEM Hospital & Research Centre.
Background
Carcinoma Gall bladder is a common problem especially in the Gangetic plane of India.Generally patients present late for the surgery. But, when it is diagnosed at an early stage laparoscopic radical cholecystectomy is a viable option. In this video we demonstrate a case of Radical Cholecystectomy in a 75 yr old Female who presented with GB growth limited to the gall bladder (T1b)
Technique
Patient Position- supine with legs split apart.
Surgeon Position-Left side of patient, Camera Assistant on left side of surgeon
Port Position- 5 mm ports-epigastric region,Lt Hypochondriac region,Lt Lumbar region
10 mm port above umbilicus and Lt Hypochondriac region
Pneumoperitoneum is created with CO2
Lymphadenectomy is performed using hilar, pericholedochal, coeliac group of lymphnodes.
Wedge resection of the IV B and V segments are done using harmonic shears / hook-which doubles as a CUSA device. Visible large ducts and vessels are clipped / suture ligated.
Haemostasis is achieved using Argon Plasma Coagulation.
POST OP Course- patient was kept for a day in ICU for observational purposes and was switched to the ward on 1st postoperative day.
She had an uneventful recovery and was ambulant from the evening of POD 1.She was discharged on POD 4 after removing her drains.
Conclusion
Laparoscopic radical cholecystectomy is a novel approach to early Gall bladder cancer.It is feasible with very good results but it needs the surgeon to have exceptional laparoscopic HPB skills
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