Laparoscopic completion radical cholecystectomy for T2 gallbladder cancer
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The role of minimally invasive surgery in the surgical management of gallbladder cancer is a matter of controversy. Because of the authors’ growing experience with laparoscopic liver and pancreatic surgery, they have begun offering patients laparoscopic completion partial hepatectomies of the gallbladder bed with laparoscopic hepatoduodenal lymphadenectomy.
The video shows the steps needed to perform laparoscopic resection of the residual gallbladder bed, the hepatoduodenal lymph node nodes, and the residual cystic duct stump in a setting with a positive cystic stump margin. The skin and fascia around the previous extraction site are resected, and this site is used for specimen retrieval during the second operation.
To date, three patients have undergone laparoscopic radical cholecystectomy with hepatoduodenal lymph node dissection for gallbladder cancer. The average number of lymph nodes retrieved was 3 (range, 1–6), and the average estimated blood loss was 117 ml (range, 50–200 ml). The average operative time was 227 min (range, 120–360 min), and the average hospital length of stay was 4 days (range, 3–5 days). No morbidity or mortality was observed during 90 days of follow-up for each patient.
Although controversy exists as to the best surgical approach for gallbladder cancer diagnosed after routine laparoscopic cholecystectomy, the minimally invasive approach seems feasible and safe, even after previous hepatobiliary surgery. If the previous extraction site cannot be ascertained, all port sites can be excised locally. Larger studies are needed to determine whether the minimally invasive approach to postoperatively diagnosed early-stage gallbladder cancer has any drawbacks.
KeywordsCancer Pancreato Bilio Cancer Hepato Cancer Cholecystectomy Gallbladder Common Bile Duct
Andrew A. Gumbs is a consultant for Ethicon, a proctor and course instructor for Covidien, and a proctor for Novare Surgical. He has received honoraria from Novare Surgical and Applied Medical. John P. Hoffman has no conflicts of interest or financial ties to disclosure.
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