Robotic Hepatic Bisegmentectomy (s4b + s5) and Hilar Lymphadenectomy for Incidental Gallbladder Cancer Using...

Area of Science:

• Surgical Oncology
• Minimally Invasive Surgery
• Hepatobiliary Surgery

Background:

• Gallbladder carcinoma is a rare malignancy with a poor prognosis, often diagnosed incidentally.
• Laparoscopic cholecystectomy is a common procedure, but can sometimes reveal unexpected gallbladder cancer.
• Radical resection is crucial for managing gallbladder cancer, often requiring complex liver resections and lymphadenectomy.

Observation:

• A 73-year-old patient diagnosed with T2a gallbladder carcinoma post-cholecystectomy underwent a multidisciplinary team-decided radical resection.
• The procedure involved a robotic bisegmentectomy (liver segments 4b and 5) utilizing a Glissonian approach and a hilar lymphadenectomy.
• The robotic approach was chosen for its potential benefits in complex oncologic resections.

Findings:

• The robotic surgery was completed in 300 minutes with minimal blood loss (120 mL) and no transfusions.
• Postoperative recovery was uneventful, with discharge on the fourth day.
• Final pathology confirmed no residual disease in the liver and no metastases in 16 removed lymph nodes.

Implications:

• Robotic surgery is a safe and feasible option for radical treatment of incidentally discovered gallbladder cancer.
• The Glissonian approach facilitates precise anatomic resection of liver segments 4b and 5.
• This video serves as a valuable educational resource for oncologic surgeons performing challenging hepatobiliary procedures.