[Laparoscopic cholecystectomy--surgical standard in cholelithiasis].

Area of Science:

• Minimally Invasive Surgery
• Surgical Oncology

Context:

• Laparoscopic surgery has advanced significantly, with laparoscopic cholecystectomy (LCCE) leading the way.
• LCCE is now the preferred treatment for cholecystolithiasis in most surgical centers, representing the most common minimally invasive technique.
• Over 90% of cholecystectomies in specialized clinics are performed laparoscopically, establishing it as an evidence-based standard of care.

Purpose:

• To highlight the evolution and current status of laparoscopic cholecystectomy (LCCE) in treating gallstones.
• To define the oncological limitations of LCCE in managing gallbladder carcinoma.
• To outline the appropriate surgical approaches for different stages of gallbladder cancer.

Summary:

• Laparoscopic cholecystectomy (LCCE) is the gold standard for gallstone treatment, widely adopted due to its minimally invasive nature.
• While effective for gallstones, LCCE is only indicated for Tis and T1 gallbladder cancer.
• Radical oncologic resection with lymph node dissection is necessary for T2 and T3 gallbladder cancer; T4 tumors warrant only laparoscopic biopsy due to poor prognosis.

Impact:

• LCCE has become the established, evidence-based procedure for gallstone management, with open cholecystectomy reserved for specific indications.
• Accurate staging of gallbladder carcinoma is crucial to determine the appropriate surgical strategy, ensuring optimal oncologic outcomes.
• This underscores the importance of integrating oncological principles into the surgical management of gallbladder disease.