title: Totally Laparoscopic Hepatic Bisegmentectomy (s4b+s5) and Hilar Lymphadenectomy for Incidental Gallbladder Cancer.
abstract: BACKGROUND
  Gallbladder cancer is suspected preoperatively in only 30 % of all patients, while the remaining 70 % of cases are discovered incidentally by the pathologist. The increasing rate of cholecystectomies via laparoscopy has led to the detection of more gallbladder cancers in an early stage, and extended resection with regional lymph node dissection has been suggested. We present a video of a totally laparoscopic liver resection (segments 5 and 4b) with regional lymphadenectomy in a patient with an incidental gallbladder cancer.
  
  
  METHODS
  A 50-year-old woman underwent laparoscopic cholecystectomy, and pathology revealed a T1b gallbladder carcinoma. The patient was referred for further treatment. Contact with the primary surgeon revealed that no intraoperative cholangiogram was performed, and the gallbladder was removed intact, with no perforation, and inside a plastic retrieval bag. Pathology revision confirmed T1b, and positron emission tomography/computed tomography was negative. The multidisciplinary tumor board recommended radical re-resection, and a decision was made to perform a laparoscopic extended hilar lymphadenectomy, along the resection of segments 5 and 4b.
  
  
  RESULTS
  Operative time was 5 h, with an estimated blood loss of 240 mL. Recovery was uneventful and the patient was discharged on the fourth postoperative day. Final pathology showed no residual disease and no lymph node metastasis.
  
  
  CONCLUSIONS
  Laparoscopic resection of liver segments 5 and 4b combined with a locoregional lymphadenectomy of the hepatoduodenal ligament is an oncologically appropriate technique, provided it is performed in a specialized center with experience in hepatobiliary surgery and advanced laparoscopic surgery. This video may help oncological surgeons to perform this complex procedure.
authors.affiliation: Department of Surgery, Sirio Libanes Hospital, São Paulo, Brazil. dr@drmarcel.com.br.
authors.forename: Marcel Autran
authors.initials: MA
authors.lastname: Machado
authors.affiliation: Department of Surgery, Sirio Libanes Hospital, São Paulo, Brazil.|Department of Gastroenterology, University of Sao Paulo, São Paulo, Brazil.
authors.forename: Fabio F
authors.initials: FF
authors.lastname: Makdissi
authors.affiliation: Department of Surgery, Sirio Libanes Hospital, São Paulo, Brazil.
authors.forename: Rodrigo C
authors.initials: RC
authors.lastname: Surjan
mesh_terms: D017081:Cholecystectomy, Laparoscopic / Q000379:methods*; D005260:Female; D005706:Gallbladder Neoplasms / Q000601:surgery*; D006498:Hepatectomy / Q000379:methods*; D006801:Humans; D033162:Incidental Findings; D008197:Lymph Node Excision / Q000379:methods*; D008875:Middle Aged; D011379:Prognosis; D014741:Video Recording