Chief of Hepato-Pancreato-Biliary surgery AdventHealth Tampa, United States
Objectives: Gallbladder cancer and intrahepatic cholangiocarcinoma have known tendency to metastasize to portal lymphnodes. A systematic portal lymphadenectomy is therefore required as a routine part of the oncological operation beside the liver resection. Anatomical complexity of porta hepatic structures create a significant technical challenge in performing aggressive lymphadenectomy via minimally invasive method. In this video, we describe our technique of robotic systematic portal lymphadenectomy as a part of gallbladder cancer resection.
Methods: 71 year old woman presented with a malignant appearing mass at the fundus of her gallbladder. A CT scan confirmed a 4.3 cm arterially enhancing tumor without any evidence of invasion into the adjacent liver parenchyma. A robotic radical cholecystectomy with systematic portal lymphadenectomy was performed using an Xi Da Vinci Robot. After resection of the gallbladder with part of segment 4/5 enbloc, the lymphadenectomy begun along the gastrohepatic ligament, left gastric and common hepatic artery. Lymphnodes and lymphatic channels within the hepatoduodenal ligaments were radically resected and labeled based on their locations according to the Japanese classification of lymphnode stations. The cystic duct stump was also sent for a frozen section examination to excude the need for a common bile duct excision.
Results: The operation was successful with negligible blood loss and an uneventful recovery. The final pathology confirmed T1BN0M0 adenocarcinoma of the gallbladder and the cystic duct margin was negative for neoplasia. 18 lymphnodes were removed without evidence of nodal metastasis.
Conclusion: Robotic systematic portal lymphadenectomy is safe and feasible with excellent lymphnode yield. The short-term oncological outcome using the robotic system appears promising for the treatment of gallbladder cancer.
