1st report of unexpected true left-sided gallbladder treated with robotic approach

True left-sided gallbladder (T-LSG) occur when the gallbladder is positioned to the left of the ligamentum teres and falciform ligament and under the surface of the left liver lobe.

Patient is 29-year-old caucasian male, presenting with 9-month history of epigastric right upper quadrant (RUQ) colic pain. RUQ Ultrasound reported cholelithiasis, gallbladder wall thickening, and no intrahepatic biliary dilation.

Robotic cholecystectomy was the chosen approach. When visceral surface of the liver was exposed, anomalous location of the gallbladder was noted, left to the round ligament. A cystic duct with a "hairpin" configuration and a very cephalad cystic artery were identified. Cholecystectomy was performed safely and uneventfully.

No change of port setting was required with the robotic approach. The ICG-aided cholangiography improved surgeon's ability to recognize the concomitant vascular and biliary anomalies. However, no definitive conclusion can be drown until further experience and volume are achieved.