Posted on 2023-09-20 02:05:49 by Sathish

        Radical Laparoscopic Cholecystectomy is performed for gall bladder cancer. Most of the time gall bladder cancer is associated with gall stones. Pre operative diagnosis of gall bladder cancer is suspected by presence of large mass in the gall bladder during ultrasonographic examination of abdomen. But to some extent the gall bladder cancer is confirmed with pre operative PET scan. After the diagnosis of gall bladder cancer, full evaluation of gall bladder and biliary system will be done and the patient will be prepared for surgery.

        Commonly this Laparoscopic Radical Cholecystectomy is done under general anaesthesia.  All investigations relevant to general anaesthesia is done along with LFT and in case of other systemic disease the concerned specialist opinion must be obtained. After anaesthesiologist evaluation patient will be submitted for radical laparoscopic cholecystectomy. Where ever facilities available for ICG study with compatible laparoscopic system, ICG is injected prior to surgery to delineate the common bile duct so that injury to CBD can be avoided. Forty-five minutes after injection of ICG intravenously, most of the ICG will be concentrated in the biliary system. This can be seen by compatible laparoscopic system.

   The procedure is done similar to routine laparoscopic cholecystectomy. There are few differences between routine laparoscopic cholecystectomy and radical laparoscopic cholecystectomy. They are,

  1. Extreme care will be taken to remove lymph nodes present in the area of Calot’s triangle.
  2. Thin rim of liver tissue about, 1cm will be removed close to the gall bladder.
  3. Entire cystic duct will be removed without damaging common bile duct.
  4. Lymphatics present over the hepatoduodenal ligament will be removed.
  5. Better to avoid gall bladder rupture during surgery which prevent the spillage of tumour cell into the abdominal cavity.

        The combined use of harmonic scalpel and bipolar diathermy helps to complete the dissection. Once the dissection is over, the specimen is removed through Endo-bag. Once the specimen is removed it will be sent for histopathology examination (Biopsy) which confirms the cancer.

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