Robotic radical cholecystectomy with histological surprise

Abstract

Introduction: Gallbladder cancer is the most common malignant tumor of the biliary system. The only potentially curative option for patients with gallbladder cancer is radical resection. This is one of the early reports first that describes the successful application of robotic radical cholecystectomy in a locally gallbladder cancer patient. Methods: A 46-year-old gentleman with no comorbidities presented with dull aching right hypochondrial pain for 1 month. His per abdomen examination, liver function and renal function tests were essentially normal. CECT abdomen showed locally advanced mass in gallbladder infiltrating segment 4b and 5. With this he was diagnosed to have locally advanced carcinoma of gallbladder. Robotic radical cholecystectomy was contemplated with lymphadenectomy. On staging laparoscopy showed no evidence of intraabdominal metastasis. Cystic duct arose from right hepatic duct. Frozen section of cystic duct showed no evidence of malignancy. Liver resection of Segment 4b and 5 was done using the help of CUSA and bipolar diathermy. The procedure was successfully completed in 320 minutes. Blood loss was 150 ml. There was no intraoperative complications and drain was removed on post-operative day 5, then discharged on the same day. Histopathology report revealed - moderately differentiated squamous cell carcinoma with no malignancy in 7 lymph nodes examined, (pT3N0M0). He was subjected for adjuvant therapy. Conclusion: The robotic radical cholecystectomy in locally advanced carcinoma gallbladder is safe and feasible. With robotic surgery system well suited for subtle dissections in a deep and narrow space, this has the potential to be viable.