Laparoscopic radical cholecystectomy and Roux-en-Y choledochojejunostomy for gallbladder cancer.
BACKGROUND
Although laparoscopic cholecystectomy was one of the first laparoscopic procedures, gallbladder cancer has been one of the last malignancies tackled with minimally invasive techniques. This video reviews the minimally invasive approaches to preoperatively suspected gallbladder cancer.


METHODS
Like the standard laparoscopic cholecystectomy, the minimally invasive procedure is performed with four trocars. The surgeon operates with the patient in the French position. A totally laparoscopic radical cholecystectomy including wedge resections of segments IVB and V is undertaken with hepatoduodenal lymphadenectomy and common bile duct excision. The biliary system is reconstructed via a laparoscopic choledochojejunostomy.


RESULTS
Six patients have undergone laparoscopic radical cholecystectomy. Three of these patients were found to have gallbladder cancer according to the final pathology. All the final surgical margins were negative, and the average lymph node retrieval was 3 (range, 1-6).


CONCLUSIONS
The minimally invasive approach to gallbladder cancer is feasible and safe. It should currently be performed in high-volume centers with expertise in both hepatobiliary and minimally invasive surgery. Larger trials are needed to determine whether either the open or laparoscopic approach offers any advantage.
Gumbs
Andrew A
AA
Department of Surgical Oncology, Fox Chase Cancer Center, 333 Cottman Avenue, C-308, Philadelphia, PA 19111, USA. aagumbs@gmail.com
Hoffman
John P
JP
D000713:Anastomosis, Roux-en-Y; D000714:Anastomosis, Surgical; D017081:Cholecystectomy, Laparoscopic / Q000379:methods*; D003135:Common Bile Duct / Q000601:surgery*; D005706:Gallbladder Neoplasms / Q000601:surgery*; D006498:Hepatectomy; D006801:Humans; D007583:Jejunum / Q000601:surgery*; D008099:Liver / Q000601:surgery*; D008197:Lymph Node Excision; D014741:Video Recording