Extent of liver resection for incidental gallbladder cancer: Anatomic versus nonanatomic approaches in T2-T3 disease.

Robotic reoperative management of recurrent gallbladder disease after subtotal cholecystectomy: a contemporary single-institution experience.

Review of Minimally Invasive Surgical Treatment of Gallbladder Cancer.

Cystic duct malformation can increase the complexity and risk of adverse events in laparoscopic cholecystectomy (LC). The aim of this study was to detemine the benefits of training with a three-dimensional (3D) printed model of cystic duct malformation for trainees. From January 2019 to January 2024, 14 trainees were divided into two groups, the 3D training group (n = 6) and the No-3D training group (n = 6), based on whether they used a 3D-printed model for training. After the training was completed, data on LCs performed by the 12 trainees were compared to the two groups. The 3D training group completed 315 LCs within 6 months, while the No-3D training group completed 375 LCs. There were no significant differences in gender, age, or surgical experience between the two groups. In comparison to the No-3D training group, the 3D training group had a shorter operation time (35.6 ± 18.5 min vs. 39.7 ± 20.8 min, P = 0.007), a higher rate of recognizing cystic duct malformations (32/36, 88.9% vs. 29/48, 60.4%, P = 0.004), a lower rate of surgeon changes (7.3% vs. 12.5%, P = 0.023), and a lower incidence of total adverse events (11.1% vs. 16.5%, P = 0.041). Training with a 3D printed model of cystic duct malformation for junior surgeons can reduce the operation time, enhance identification of cystic duct malformations, enable trainees to complete operation independently, decrease adverse events, and improve safety.

Same-session endoscopic retrograde direct cholangioscopy-assisted laparoscopic cholecystectomy: real-time intraluminal navigation for prevention of cystic duct stone residual.

Jawbone defects following cystectomy for cysts of the jaw may cause postoperative complications such as pathological fractures and secondary infections. Therefore, different bone-grafting procedures have been developed. Novel cotton-like bone graft material composed of β-tricalcium phosphate, poly-L-lactic acid, and polyglycolic acid (β-TCP/PLLA/PGA) has handling properties, three-dimensional shapeability, and bone forming ability, and has potential clinical utility for bone formation. However, no studies have evaluated the clinical outcomes of the novel β-TCP/PLLA/PGA in patients of oral and maxillofacial surgery. Thus, we evaluated the usefulness of β-TCP/PLLA/PGA in bone formation within jawbone defects following cystectomy. : 28 patients (19 males and 9 females; mean age: 47.5 years) who visited the Department of Oral and Maxillofacial Surgery, Shimane University Hospital, between November 2022 and April 2024 were included. They underwent cystectomy for cysts of the jaw (maxilla or mandible) and were grafted with β-TCP/PLLA/PGA. All excised cyst were submitted for histopathological examination. Patient demographics, clinical data, and computed tomography (CT) images were retrospectively evaluated to assess the defect dimensions, CT values, and bone continuity of the jawbone defects. Data on postoperative complications were obtained from medical records. Among the 28 cystic lesions (6 maxillary and 22 mandibular jaw cases), 27 were odontogenic cysts (26 odontogenic cysts and 1 orthokeratinized odontogenic cyst), and 1 was a non-odontogenic cyst (nasopalatine duct cyst). Both long- and short-axis lengths of the jawbone defect revealed a significant decrease at 6 months postoperatively compared with the preoperative and 1-month postoperative values. The CT values were significantly increased from 1 month to 6 months postoperatively (P<0.05). At 6 months postoperatively, 39.3% of the patients achieved full bone continuity. No serious adverse events were observed. β-TCP/PLLA/PGA demonstrated excellent handling characteristics and clinical safety as a novel cotton-like bone graft material for jawbone defects following cystectomy.

Benign midline cervical tumors, such as thyroglossal duct cysts (TDCs) and dermoid cysts, are typically removed via cervical incisions, often resulting in noticeable scars. This study evaluates the feasibility, safety, and outcomes of endoscope-assisted transoral resection with concealed incisions. A retrospective analysis was performed on 24 patients who underwent endoscopic transoral excision at Qilu Hospital (2018-2024). Preoperative MRI or CT was performed to assess tumor characteristics. Incisions were made in the oral vestibule or floor of the mouth mucosa, tailored to tumor location. All procedures were successfully completed endoscopically. Five patients experienced transient lower lip numbness; one patient with a thyroglossal duct fistula developed a seroma and infection, which resolved with drainage. At 3 months postoperatively, no oral dysfunction was observed. The mean Visual Analog Scale (VAS) score for cosmetic satisfaction was 9.1 ± 0.8, indicating high patient satisfaction. No recurrences were observed during follow-up. Transoral endoscopic resection is a feasible alternative that avoids externally visible scars for selected patients with benign midline cervical neoplasms, achieving satisfactory cosmetic and functional outcomes with no compromise to safety.

Gallbladder torsion (GT) is a rare, life-threatening surgical emergency that disproportionately affects older adults. Diagnosis is frequently complicated by multimorbidity and age-related anatomical changes, which mask typical symptoms and mimic acute cholecystitis. We report a complex case of GT and present a structured narrative review of 180 cases to provide evidence-based strategies for early recognition and surgical management. We report the case of an 84-year-old male with sudden-onset severe right upper quadrant pain, nausea, and vomiting. Preoperative computed tomography revealed a markedly distended gallbladder with gallstones and pericholecystic fluid, and torsion was highly suspected but not definitively confirmed until laparoscopic exploration. Laparoscopic exploration confirmed 360° clockwise torsion of the gallbladder around the cystic duct and artery. Laparoscopic cholecystectomy was successfully performed, and the patient recovered uneventfully. Pathological examination confirmed transmural hemorrhagic necrosis and acute inflammation, consistent with gangrenous cholecystitis secondary to torsion. GT is a critical differential diagnosis for acute abdomen in older adults. Age-related anatomical changes require a high index of suspicion, as clinical presentations often overlap with routine cholecystitis. Early recognition of specific imaging markers and immediate laparoscopic intervention are vital to prevent gangrene, perforation, and mortality in this vulnerable population.

Bile duct injury from laparoscopic cholecystectomy is an uncommon complication. Percutaneous cystic duct embolization has been used to treat bile leaks from the cystic duct in patients who are not surgical candidates or who have failed endoscopic retrograde cholangiopancreatography (ERCP). A case of a 48-year-old man who underwent cholecystectomy complicated by bile leak and biloma in the gallbladder fossa requiring drain placement is presented. The patient initially underwent ERCP with sphincterotomy of the major duodenal papilla and common bile duct stent placement. However, due to a persistent bile leak, a percutaneous cystic duct embolization procedure was performed through the gallbladder fossa using a microvascular plug and the LAVA® Liquid Embolic System (LES) in a retrograde fashion. The output from the preexisting drain in the gallbladder fossa stopped within 3 days, and the drain was removed after follow-up abdominal computed tomography at 1 week, which confirmed resolution of the biloma. The LAVA LES has not been reported in the literature with respect to cystic duct embolization.

Surgical resection remains the primary treatment modality for well-differentiated thyroid carcinoma. However, hypoglossal nerve injury following thyroidectomy represents a rare complication. We report a case of bilateral hypoglossal nerve palsy in a 57-year-old female patient who underwent bilateral total thyroidectomy with neck dissection and thyroglossal duct cyst excision under general anesthesia. Comprehensive imaging and electrophysiological studies confirmed bilateral hypoglossal nerve dysfunction, although surgical re-exploration revealed anatomically intact nerves. Despite empirical steroid treatment, neurological improvement was limited. The patient subsequently underwent intensive, multidisciplinary neurorehabilitation. Over the following months, swallowing function gradually improved, allowing a return to oral intake, although mild dysarthria persisted. This case presents a complex and rare neurological complication following thyroid surgery. Although thyroidectomy techniques are well-established, preoperative assessment should carefully consider the potential risk factors for hypoglossal nerve injury to optimize surgical outcomes.

Mixed neuroendocrine-non-neuroendocrine neoplasms (MiNENs) are rare tumors comprising both neuroendocrine and non-neuroendocrine components, with each component constituting at least 30% of the tumor. MiNEN of the extrahepatic bile duct is particularly uncommon and is often associated with a poor prognosis. We report the case of a 63-year-old male with jaundice, who was diagnosed with cholangiocarcinoma at the confluence of the cystic duct. Imaging and endoscopic cholangiography revealed perihilar-to-distal bile duct involvement, accompanied by bulky lymph node metastases. Endoscopic biliary drainage was performed, and biopsy revealed adenocarcinoma. The patient received four cycles of neoadjuvant chemotherapy with gemcitabine, cisplatin, and durvalumab. The tumor and lymph nodes decreased in size, enabling curative pancreatoduodenectomy. Pathological examination revealed adenocarcinoma with small-cell neuroendocrine components, confirming MiNEN. The therapeutic response was grade 2, and curative resection was achieved. Four months after surgery, the patient developed para-aortic lymph node recurrence, prompting chemotherapy resumption; however, he died 2 years after treatment initiation. MiNENs with neuroendocrine carcinoma components are associated with a poor prognosis. Despite the initial response to neoadjuvant chemotherapy and curative resection, early recurrence indicates tumor aggressiveness. Additional case reports and further research exploring optimal treatment strategies are required to improve outcomes.

Nasopalatine duct cysts may present with atypical radiographic features when arising in grafted alveolar cleft regions. A patient with cleft lip and palate presented with a well-defined radiolucent lesion in the anterior maxilla following alveolar bone grafting. Imaging demonstrated a unilocular lesion associated with displacement of the incisive canal, mimicking other odontogenic and nonodontogenic cysts. The unusual location and surgical history posed diagnostic challenges. Local trauma related to grafting may have contributed to cyst development. Careful radiographic assessment is essential for accurate differential diagnosis and appropriate management.

Laparoscopic common bile duct exploration (LCBDE) remains an effective single-stage strategy for choledocholithiasis, but declining utilization has raised concerns about diminishing operative experience and training exposure among contemporary surgeons. We evaluated institutional trends in LCBDE, intraoperative cholangiography (IOC), and resident participation and identified predictors of successful duct clearance. This retrospective single-center cohort study (2012-2021) included adults undergoing laparoscopic or robotic cholecystectomy. Patients were grouped as single-stage LCBDE with cholecystectomy or two-stage management with ERCP and endoscopic sphincterotomy followed by cholecystectomy. Cases were identified using CPT and ICD procedure codes cross-referenced with operating room logs. Data were abstracted from the electronic medical record. Primary outcomes were temporal trends in LCBDE, IOC utilization, and resident participation. Secondary outcomes were predictors of successful LCBDE. LCBDE succeeded in 240/291 cases (82.4%). Failures occurred exclusively during transcystic exploration, most commonly due to an inability to cannulate the cystic duct (43%). Median length of stay was shorter after successful LCBDE (1 vs 3days, p < 0.001). Surgeons in successful cases had greater experience (median 17.5 vs 12.9years, p = 0.03). On multivariable analysis, surgeon experience independently predicted success (OR 1.04 per year, 95% CI 1.004-1.078), whereas surgeon specialty was not significant after adjustment. Of 303 LCBDE patients, 291 met inclusion criteria; among 339 two-stage patients, 257 met inclusion criteria. Institutionally, annual LCBDE volume declined (trend p < 0.05), IOC utilization decreased (66% in 2018 to 54% in 2021), and resident involvement fell (91.8% in 2014 to 69.6% in 2021), with per-resident exposure declining from 2.2 to 0.9 cases per year. LCBDE achieves high duct-clearance rates and shorter hospitalization when successful. Surgeon experience, rather than specialty, independently predicts success, underscoring a clinically meaningful learning curve. Declines in LCBDE volume, IOC utilization, and resident exposure highlight the need for training strategiesincluding simulation, standardized workflows, and improved case accessto preserve competency.

Bile leaks are serious complications after cholecystectomy. Their management is usually individualised and requires interdisciplinary surgical and endoscopic expertise. In cases of leaks caused by aberrant bile ducts, closure of the leak may be impossible-depending on the size of the drained liver area; therefore, drainage-e.g., by means of a biliodigestive anastomosis-is required. We report the case of a 66-year-old female patient referred from an external hospital with a bile duct leak caused by an aberrant bile duct of segments V and VIII and concomitant cystic duct stump insufficiency following laparoscopic cholecystectomy. Due to the extent of the drained liver area, surgical management with drainage of the bile duct was pursued. Preservation of the option for ERCP in the event of potential secondary complications, such as bile duct strictures, was considered important. Given the prior laparoscopic surgery, a minimally invasive approach was favoured. A robot-assisted exploration of the hepatic hilum and bile ducts was performed. Primary anastomosis was not feasible, due to the distance between the structures. For drainage of the bile duct, a combined anastomosis was created: the cystic duct stump was anastomosed to the aberrant bile duct on the posterior wall, and a biliodigestive anastomosis using a Roux-en-Y reconstruction was performed on the anterior wall. Intraoperatively, a biliary stent was placed via the cystic duct stump into the aberrant bile duct. The postoperative course was uneventful, with no recurrence of the bile leak. The patient was discharged after 11 days. The biliary stents were removed after 7 weeks, demonstrating good contrast drainage from the aberrant bile duct into the biliodigestive anastomosis. Robot-assisted management of bile duct injuries should be considered in patients with prior laparoscopic surgery. Roux-en-Y reconstruction incorporating the cystic duct stump to preserve the option of ERCP is a viable treatment strategy for leaks originating from larger aberrant bile ducts.

Papillary thyroid carcinoma (PTC) is the most prevalent endocrine malignancy, typically presenting as a solid thyroid nodule. While cervical lymph node metastases are common, purely cystic nodal metastases involving the upper cervical lymph nodes are uncommon. Furthermore, the involvement of a thyroglossal duct cyst (TGDC) by PTC is also infrequent. We present the case of a 35-year-old male who presented with a long-standing, painless right submandibular swelling. Imaging revealed a complex cystic picture involving both upper cervical lymph nodes and a TGDC, alongside a suspicious thyroid nodule. Following surgical intervention, histopathology confirmed a classic variant of PTC with extensive cystic nodal metastases and TGDC involvement. The patient was successfully managed with high-dose Iodine-131 therapy and is doing well with suppressive thyroxine therapy. This case highlights the initial presentation of cystic neck mass in PTC in adults and highlights the pivotal role of nuclear medicine in the comprehensive management of differentiated thyroid carcinoma.

This study aimed to investigate morphological features on magnetic resonance cholangiopancreatography (MRCP) that may help distinguish benign from malignant causes of isolated main pancreatic duct (MPD) dilation detected without a visible mass or obstructive pathology, and to propose a management strategy applicable in clinical practice. Ninety-two patients with isolated MPD dilation detected on MRCP at our institution between November 2015 and March 2025 were retrospectively evaluated. The following MRCP parameters were assessed: maximum pancreatic duct diameter, location of dilation, dilation pattern, presence of duct stricture and stricture segment length with termination pattern if present, parenchymal atrophy, pancreatic duct anomalies, common bile duct-pancreatic duct junction configurations, and presence of branch duct dilation or cysts. Cases were classified as benign in 85.9% (n=79) and malignant in 14.1% (n=13). Stricture segment length was significantly greater in the malignant group, with a median of 7.0 mm (Q1-Q3: 5.0-12.0) compared to 3.7 mm (Q1-Q3: 2.5-7.0) in the benign group. Although branch duct dilation/cyst size was larger in the malignant group (median: 9.6 mm vs. 6.8 mm), this difference was not statistically significant (p > 0.05). Regarding dilation location, the segment with maximum dilation was predominantly at the pancreatic neck in malignant cases (53.8%), whereas the pancreatic head was predominant in benign cases (88.6%). Stricture termination patterns differed significantly between groups: abrupt termination predominated in malignant cases (88.9%), while tapering termination was more frequent in the benign group (72.7%). MRCP is a valuable non-invasive tool for the further characterization of isolated MPD dilation. Findings such as increased stricture segment length (≥7 mm), dilation localized to the pancreatic neck, and abrupt stricture termination may help distinguish malignant from benign causes. These morphological features may support clinical decision-making when determining the need for further invasive investigations. · Stricture segment length ≥7 mm and abrupt duct termination are significant morphological features suggestive of malignancy in isolated MPD dilation.. · Maximum dilation localized to the pancreatic neck may raise suspicion for an underlying malignancy, though further validation is required.. · MRCP serves as a valuable adjunct in the diagnostic work-up of pancreatic duct changes, potentially helping to identify cases that require invasive investigations such as Endoscopic ultrasound (EUS) or surgical consultation.. · Serum biomarkers (CA 19-9, CEA) showed no significant difference between benign and malignant groups, highlighting the importance of morphological evaluation.. · Çınar E, Uysal FT, Gürbüz AF et al. Evaluation of MRCP Findings in Distinguishing Benign from Malignant Causes of Isolated Main Pancreatic Duct Dilation. Rofo 2026; DOI 10.1055/a-2863-2316.

A duplicated cystic duct draining a single gall bladder is an exceedingly rare congenital biliary anomaly. Fewer than 25 cases have been described in published literature, and the condition is almost never diagnosed before surgery. We report a 19-year-old male who presented with recurrent right upper quadrant pain. Abdominal ultrasonography confirmed cholelithiasis but revealed no biliary ductal abnormality. During elective laparoscopic cholecystectomy, meticulous dissection of Calot's triangle unexpectedly identified two separate cystic ducts, both draining a single gall bladder. Each duct was individually traced to confirm its distal course, then clipped and divided under direct vision after establishing the critical view of safety. The procedure was completed laparoscopically without complication. The patient was discharged on the post-operative day 2 and remained well at the follow-up. This case underscores that standard pre-operative imaging does not guarantee normal biliary anatomy and that systematic, unhurried dissection with a critical view of safety remains the only reliable safeguard against inadvertent bile duct injury.

Left thoracic duct cyst as a rare differential diagnosis

Symptomatic gallbladder (GB) duplication is a rare congenital anomaly that poses a significant surgical challenge due to anatomical variability, increasing the risk of bile duct injury or retained GB syndrome. We present the case of a 58-year-old woman with symptomatic cholelithiasis in a duplicated GB, who underwent a robotic single-site cholecystectomy using the da Vinci SP ® system. Intraoperative indocyanine green (ICG) fluorescence imaging was instrumental in delineating the biliary tree, enabling the successful resection of both GBs and their respective cystic ducts and arteries without complications. The articulated instruments of the robotic platform provided the dexterity required for precise dissection, particularly as one GB was partially embedded in the liver parenchyma. This case demonstrates that robotic single-site cholecystectomy with ICG fluorescence imaging is a safe, feasible and effective approach for managing GB duplication, enhancing anatomical identification to minimise surgical risks in aberrant biliary anatomy.

The complete anatomy of the cystic duct: A meta-analysis with implications for hepatobiliary surgery.