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Laparoscopic radical cholecystectomy and Roux-en-Y choledochojejunostomy for gallbladder cancer

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Abstract

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).

Conclusion

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.

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Fig. 1

References

  1. 1.

    Gumbs AA, Milone L, Geha R et al (2009) Laparoscopic radical cholecystectomy. J Laparoendosc Adv Surg Tech A 19:519–520

  2. 2.

    D’Angelica M, Dalal KM, DeMatteo RP et al (2009) Analysis of the extent of resection for adenocarcinoma of the gallbladder. Ann Surg Oncol 16:806–816

  3. 3.

    Gumbs AA, Gayet B (2008) The laparoscopic duodenopancreatectomy: the posterior approach. Surg Endosc 22:539–540

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Disclosures

Andrew A. Gumbs is a consultant for Ethicon, a proctor and course instructor for Covidien, and a proctor for Novare Surgical. He has received honoraria from Novare Surgical and Applied Medical. John P. Hoffman has no conflicts of interest or financial ties to disclose.

Author information

Correspondence to Andrew A. Gumbs.

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Gumbs, A.A., Hoffman, J.P. Laparoscopic radical cholecystectomy and Roux-en-Y choledochojejunostomy for gallbladder cancer. Surg Endosc 24, 1766–1768 (2010) doi:10.1007/s00464-009-0840-5

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Keywords

  • Gallbladder cancer
  • Laparoscopic cholecystectomy
  • Roux-en-Y choledochojejunostomy