Shashikiran J Nanjakla, Hemanga Bhattacharjee, Praveen Kumar, Manjunath Bale, Ajit Oberoi, Suhani Suhani, Rajinder Parshad. All India Institute of Medical Sciences,New Delhi
INTRODUCTION: Gallbladder malignancy is the most prevalent biliary tract malignancy in India. Laparoscopy was restricted only for staging purposes initially in view of concerns regarding feasibility of achieving an adequate Liver margin, lymph node yield and the risk of intraoperative peritoneal dissemination.
METHODS AND PROCEDURES: Patient positioned in French position under general anesthesia . Pneumoperitoneum was created from supraumbilical incison. 12mm camera port inserted and staging laparoscopy done which did not reveal any evidence of metastasis. Two more 5mm ports inserted just above the level of umbilicus in right and left mid clavicular line. 12mm port was placed just left of the midline in epigastric region. Duodenum was kocherized – Inferior Vena cava identified. Initial lymph node dissection started along the common hepatic artery and control was taken using the vascular sling, Dissection was continued up till the Hilum. CBD skeletonised and slinged away to harvest pericholedochal lymphnodes. Periportal lymph nodes harvested. Cystic duct and artery identified clipped and divided separately. Cystic duct margin was sent for frozen section analysis which came out to be negative for malignancy. Liver capsule scored with monopolar cautery with ~ 2.5-3 cm margin all around. Wedge resection done of segment 4b and part of segment 5 of liver using harmonic. Hemostasis achieved and no obvious bile leak noted. Drain placed and specimen removed in Endo bag from epigastric port site. Cut section revealed an ulcero-proliferative growth in the fundus limited to gallbladder wall without any stones. Postoperative course was uneventful, drain was removed on POD3 and patient was discharged on POD4. Total operative time was 240 minutes. Total blood loss was 200 ml.
RESULTS: At our institute, we have been offering laparoscopic radical cholecystectomy to patients with suspected early-stage gallbladder cancer. Care is taken to avoid bile spillage and to achieve adequate lymph node harvest. The procedure was uneventful. Patient is doing well on follow up. Histopathology revealed a moderately differentiated adenocarcinoma pT2aN0M0 without any perineural or lymphovascular emboli. Liver wedge was free of tumor. None out of 12 lymphnodes were involved by the tumour.
CONCLUSION: Laparoscopic radical cholecystectomy is a feasible alternative to open radical cholecystectomy in selected cases.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 95163
Program Number: V351
Presentation Session: Video Loop Day 3
Presentation Type: VideoLoop