Totally Laparoscopic Hepatic Bisegmentectomy (s4b+s5) and Hilar Lymphadenectomy for Incidental XXXX .

@entity1 @entity66 @entity190 @entity5 @entity3 @entity1086
BACKGROUND: @entity1086 is suspected preoperatively in only 30 % of all @entity1 , while the remaining 70 % of cases are discovered incidentally by the pathologist. The increasing rate of cholecystectomies via laparoscopy has led to the detection of more @entity1086 in an early stage, and extended resection with regional lymph node dissection has been suggested. We present a video of a totally laparoscopic liver resection (segments 5 and 4b) with regional lymphadenectomy in a @entity1 with an incidental @entity1086 . METHODS: A 50-year-old @entity1 underwent laparoscopic cholecystectomy, and pathology revealed a T1b @entity1086 . The @entity1 was referred for further treatment. Contact with the primary surgeon revealed that no intraoperative cholangiogram was performed, and the gallbladder was removed intact, with no perforation, and inside a plastic retrieval bag. Pathology revision confirmed T1b, and positron emission tomography/computed tomography was negative. The multidisciplinary @entity5 board recommended radical re-resection, and a decision was made to perform a laparoscopic extended hilar lymphadenectomy, along the resection of segments 5 and 4b. RESULTS: Operative time was 5 h, with an estimated @entity190 of 240 mL. Recovery was uneventful and the @entity1 was discharged on the fourth postoperative day. Final pathology showed no @entity66 and no lymph node @entity3 . CONCLUSIONS: Laparoscopic resection of liver segments 5 and 4b combined with a locoregional lymphadenectomy of the hepatoduodenal ligament is an oncologically appropriate technique, provided it is performed in a specialized center with experience in hepatobiliary surgery and advanced laparoscopic surgery. This video may help oncological surgeons to perform this complex procedure.
