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Open Radical Cholecystectomy with Partial Hepatectomy for Gallbladder Cancer

Shoichi Irie, MD; Mamiko Miyashita, MD; Yu Takahashi, MD; Hiromichi Ito, MD

Cancer Institute Hospital, Gastrointestinal Cancer Center Division of Hepatobiliary and Pancreatic Surgery Cancer Institute Hospital Japanese Foundation for Cancer Research Ariake, Tokyo 135-8550

1. Introduction

2. Incision and Access to the Abdominal Cavity

  1. Incision
  2. Peritoneal Washing Cytology
  3. Incision Extension
  4. Xiphoid Process Removal
  5. Round Ligament Isolation and Ligation
  6. Wound Protection and Gallbladder Exposure

3. Evaluation of Tumor Extent

  1. Liver Ultrasonography
  2. Rule Out Peritoneal Carcinomatosis

4. Kocher Maneuver

5. Lymphadenectomy

  1. Para-Aortic Lymphadenectomy
  2. Level 8 Common Hepatic Artery Lymphadenectomy (Part 1)
  3. Level 13 Retropancreatic Lymphadenectomy
  4. Portal Vein Dissection
  5. Level 8 Common Hepatic Artery Lymphadenectomy (Part 2 - Left)
  6. Level 8 Common Hepatic Artery Lymphadenectomy (Part 2 - Right)
  7. Cystic Duct Isolation
  8. Cystic Duct Division
  9. Level 12b Hepatoduodenal Ligament (Along the Common Bile Duct) Lymphadenectomy and Common Bile Duct Dissection
  10. Cystic Artery Identification, Isolation, and Ligation
  11. Hilar Dissection
  12. Review of Progress and Anatomy

6. Partial Hepatectomy (Segments IVb and V Hepatic Resection)

  1. Right Liver Mobilization
  2. US-Guided Liver Resection Line Marking
  3. Liver Parenchyma Division
  4. Surgical Specimen Examination
  5. Hemostasis

7. Closure

  1. Drain 1 Placement
  2. Transverse Incision Closure
  3. Drain 2 Placement
  4. Midline Incision Closure
  5. Skin Closure

8. Post-op Remarks