Robotic anatomical segment IVB and V resection using Miyazaki technique with radical lymphadenectomy for gall bladder cancer

KS Awards Finalist 6: This video is one of the 8- Finalists in consideration for the top three prizes to be announced February 6th, 2021: Robotic anatomical segment IVB and V resection using Miyazaki technique with radical lymphadenectomy for gall bladder cancer; Sankar Narayanan, Kalayarasan R, Senthil G, Pottakkat B. Department of Surgical Gastroenterology, JIPMER, Puducherry, India.

Abstract: Background: Anatomical segment IVb/V resection with radical lymphadenectomy is preferred in primary gallbladder cancer (GBC) with liver infiltration and in incidental GBC patients with puckering of gallbladder (GB) bed [1]. The open technique of anatomical segment IVb/V resection has been previously reported [1]. Despite the initial criticism, minimally invasive radical cholecystectomy is recommended as a treatment option in selected GBC patients [2,3]. A stepwise description of robotic anatomical resection is described here.

Methods: A 34-year-old female was diagnosed with T1b incidental GBC after laparoscopic cholecystectomy was done elsewhere. Postoperative CT and MRI of the abdomen showed a choledochal cyst and no residual tumor in GB fossa. The patient underwent robotic (daVinci®XiTM) segment IVb/V resection with radical lymphadenectomy and choledochal cyst excision. Robotic-assisted staging laparoscopy and frozen section examination of 16b1 lymph nodes was performed [4]. Clamping of segment IVb pedicle demarcates the boundary between segment IVa and IVb. The boundary between segments V and VI was determined by clamping the right posterior pedicle. Segments IVb and V were marked by extending the horizontal line to meet the vertical line of demarcation. Results: Operative time was 330 minutes, and blood loss was 175mL. On histopathological examination, 1/16 lymph nodes showed metastasis and no residual tumor in the liver. The patient was discharged on the fifth postoperative day after an uneventful postoperative course. There is no evidence of recurrence at eight months follow up.

Conclusion: Robotic anatomical segment IVb/V resection with radical lymphadenectomy is a safe and feasible technique in selected patients with GBC.

Keywords: Gallbladder cancer, hepatectomy, robotic surgery

References Kalayarasan R, Fong Y, Agarwal A.K, Miyazaki M. Standard Radical Cholecystectomy for T1 and T2 Gallbladder Cancer. In: Clavien PA, Sarr M, Fong Y, Miyazaki M, eds. Atlas of Upper Gastrointestinal and Hepato-Pancreato-Biliary Surgery. Berlin, Heidelberg: Springer, 2016:611-622. Agarwal AK, Javed A, Kalayarasan R, Sakhuja P. Minimally invasive versus the conventional open surgical approach of a radical cholecystectomy for gallbladder cancer: a retrospective comparative study. HPB (Oxford). 2015;17(6):536-541. Han HS, Yoon YS, Agarwal AK, et al. Laparoscopic Surgery for Gallbladder Cancer: An Expert Consensus Statement. Dig Surg. 2019;36(1):1-6. CAUTION: contains narrated presentation of PowerPoints, Photos, Diagrams and robotic surgery footage, 07:53.