Robotic Cholecystectomy & Central Hepatectomy for Gallbladder Cancer

Iswanto Sucandy, MD, FACS; Andres Giovannetti, MD; Sharona B. Ross, MD, FACS; Alexander Rosemurgy, MD, FACS

Product Details
Product ID: ACS-5796
Year Produced: 2019
Length: 10 min.


Surgical treatment for gallbladder cancer (except T1a disease) involves a radical cholecystectomy or central (segment 4&5) hepatectomy with portal lymphadenectomy. We present a video of a 66-year-old woman with a history of biopsy proven, locally advanced gallbladder cancer. She underwent 3 months of neoadjuvant chemotherapy with excellent response, and decision was made to proceed with surgical management. The patient was taken to the OR and general anesthesia was administered. Access to the abdominal cavity was gained through an umbilical incision. There was no evidence of metastatic disease on diagnostic laparoscopy. The remaining robotic trocars were placed. A GelPort® was placed in the right lower quadrant for specimen extraction and assistance by a bedside surgeon. The patient was positioned in a reverse Trendelenburg and left side tilt. The falciform ligament was taken down, followed by extensive lysis of adhesions around the gallbladder. A partial Kocher maneuver was undertaken as well as lymphadenectomy in the porta hepatis. Intraoperative ultrasound was undertaken with generous biopsies of concerning areas; all of these were negative for malignancy. Robotic central hepatectomy with cholecystectomy was then undertaken using a combination of monopolar electrocautery and a robotic vessel sealer. Frozen sections of the liver resection margins were negative for malignancy. A falciform ligament flap was utilized to buttress the resection surface. The patient tolerated the operation well and was discharged home on POD 2 without complications. Robotic surgery is feasible and safe for oncologic resections. It offers improved ergonomics, 3D visualization, and greater precision in complex hepatobiliary operations.