Laparoscopic Radical Resection of Gallbladder Cancer




(1)
Department of General Surgery, Sir Run Run Shaw Hospital Zhejiang University, Hangzhou, China

 



Electronic supplementary material

The online version of this chapter at (doi: 10.​1007/​978-94-017-9840-2_​9) contains supplementary material, which is available to authorized users.


Gallbladder (GB) cancer is an aggressive malignancy, and the prognosis for most patients is poor. The median overall survival time is 10 months (Duffy et al. 2008). Patients with gallbladder cancer confined to the mucosa or submucosa (T1a) are usually diagnosed by the postoperative pathological examination, and a simple cholecystectomy is adequate for them. A radical resection of the localized gallbladder cancer, including cholecystectomy, partial hepatectomy, and skeletonization of hepatoduodenal ligament (HDL), could gain a better result in patients with gallbladder cancer invading into (T1b) or beyond (stages II–IVa) the gallbladder muscularis. Laparoscopic surgery is adopted for treating gallbladder cancer, but port-site recurrence and intra-abdominal dissemination are concerns of surgeons (Kais et al. 2014; Lee et al. 2011). The rupture of gallbladder should be avoided to prevent intra-abdominal dissemination, and the specimen should be properly retrieved from the abdominal cavity. In our institute, the plastic Endobag is routinely used to capsule the specimen in the extraction of the specimen out of the abdominal cavity to prevent port-site recurrence.


9.1 Indications and Contraindications


Indications include gallbladder cancer invading into or beyond the gallbladder muscularis and liver function of Child A to B classification. Contraindications include malignant tumor involving porta hepatis or with intra-abdominal dissemination.


9.2 Patient Position and Trocars’ Position


Patients are placed in the supine position under general anesthesia. Three surgeons are needed in the operation. The senior surgeon stands on the left side of the patient, one assistant surgeon stands on the right side of the senior surgeon manipulating the aspiration device, and the other assistant surgeon stands on the other side of the patient. Four entries are made. A supraumbilical 10-mm trocar is inserted as the observation port. A 12-mm trocar below the left costal margin is inserted as the main manipulation port. And two 5-mm trocars are inserted at the right flank area as assistant manipulation ports (Fig. 9.1).

A334129_1_En_9_Fig1_HTML.jpg


Fig. 9.1
Trocars’ position and surgeons’ position. (A) Observation port; (B) Main manipulation port; (C) Two assistant ports and the incision for removing specimen; (a) The senior surgeon stands on the left side of the patient; (b) One assistant surgeon stands on the right side of the senior surgeon controlling the aspiration device; (c) The other assistant surgeon stands on the right side of the patient

Jun 20, 2017 | Posted by in NEPHROLOGY | Comments Off on Laparoscopic Radical Resection of Gallbladder Cancer

Full access? Get Clinical Tree

Get Clinical Tree app for offline access