Port-site metastasis of unsuspected gallbladder carcinoma with ossification after laparoscopic cholecystectomy: A case report

BACKGROUNDUnsuspected gallbladder carcinoma (UGC) refers to cholecystectomy due to benign gallbladder disease, which is pathologically confirmed as gallbladder cancer during or after surgery. Port-site metastasis (PSM) of UGC following laparoscopic cholecystectomy is rare, especially after several years.CASE SUMMARYA 55-year-old man presenting with acute cholecystitis and gallstones was treated by laparoscopic cholecystectomy in July 2008. Histological analysis revealed unexpected papillary adenocarcinoma of the gallbladder with gallstones, which indicated that the tumor had spread to the muscular space (pT1b). Radical resection of gallbladder carcinoma was performed 10 d later. In January 2018, the patient was admitted to our hospital for a mass in the upper abdominal wall after surgery for gallbladder cancer 10 years ago. Laparoscopic exploration and complete resection of the abdominal wall tumor were successfully performed. Pathological diagnosis showed metastatic or invasive, moderately differentiated adenocarcinoma in fibrous tissue with massive ossification. Immuno-histochemistry and medical history were consistent with invasion or metastasis of gallbladder carcinoma. His general condition was well at follow-up of 31 mo. No recurrence was found by ultrasound and epigastric enhanced computed tomography.CONCLUSIONPSM of gallbladder cancer is often accompanied by peritoneal metastasis, which indicates poor prognosis. Once PSM occurs after surgery, laparoscopic exploration is recommended to rule out abdominal metastasis to avoid unnecessary surgery.     

Port site metastases after laparoscopic cholecystectomy for an unexpected gallbladder carcinoma

Laparoscopic cholecystectomy is a proven, well-accepted surgical technique for removing the diseased gallbladder and has rapidly become the surgical procedure of choice over conventional open cholecystectomy. Radiologists must be aware of the possibility of inadvertent dissemination of incidental gallbladder cancer during laparoscopic cholecystectomy. We report a case of this unusual complication: a patient with port site metastases after laparoscopic cholecystectomy for an unexpected gallbladder carcinoma at an early stage. Received: 28 July 1998/Accepted: 9 September 1998     

Single‐incision laparoscopic cholecystectomy for gallbladder torsion: A case report and literature review

We present a case of preoperatively diagnosed gallbladder torsion (GT) that was successfully treated by single‐incision laparoscopic cholecystectomy. An 80‐year‐old woman presented with sudden pain and a palpable mass in the right upper quadrant. Contrast‐enhanced CT revealed ischemic changes, a swollen gallbladder with a V‐shaped distortion of the extrahepatic ducts, and the gallbladder in an abnormal anatomical position; clinical findings indicated GT. We performed single‐incision laparoscopic cholecystectomy and intraoperatively found that the floating gallbladder was twisted counterclockwise by 180° around the cystic duct. After an uneventful postoperative course, the patient was discharged on postoperative day 7. Laparoscopic cholecystectomy for a GT was first performed in 1994, and since then, 28 cases, including ours, have been treated laparoscopically. Laparoscopic cholecystectomy for GT could be the standard treatment for this condition, and single‐incision laparoscopic cholecystectomy may be a good surgical option for patients with GT because of its anatomical characteristics.     

Tumor recurrence at a stapled‐anastomosis after radical laparoscopic surgery for descending colon cancer treated successfully by laparoscopic colectomy: A case report

Anastomosis using linear staplers following colonic resection has been increasingly used due to its convenience and technical safety. However, there have been few reports of stapled‐anastomotic recurrence after curative resection for colon cancer. Here, we report a rare case of suture‐line recurrence after functional end‐to‐end anastomosis. A 78‐year‐old woman underwent radical laparoscopic colectomy for advanced descending colon cancer. A postoperative 1 year follow‐up colonoscopy revealed that suture‐line recurrence had occurred. After the detection of early stage recurrent cancer, the patient underwent laparoscopic partial colectomy. This rare case of suture‐line recurrence in functional end‐to‐end anastomosis possibly occurred due to tumor implantation after curative laparoscopic surgery for advanced descending colon cancer. The follow‐up colonoscopy was helpful in diagnosing the anastomotic recurrence in its early stages. In addition, laparoscopic surgery for primary colon cancer led to successful laparoscopic treatment for recurrent cancer as a result of reduced bowel adhesion.     

Single‐port laparoscopic cholecystectomy: A comparative study in 106 initial cases

Introduction: Laparoscopic cholecystectomy has been the standard of care for gallbladder diseases since the late 1980s. Many surgeons have rapidly adopted single‐port laparoscopic cholecystectomy for gallbladder pathologies. The aim of the present study was to analyze the clinical outcome in initial single‐port laparoscopic cholecystectomy. Methods: Data from 106 consecutive single‐port laparoscopic cholecystectomies between May 2008 and April 2009 were analyzed retrospectively. We divided the patients into two groups – an early group (group I, n=56) and a late group (group II, n=50) – to compare clinical outcomes. During each procedure, only one longitudinal transumbilical incision, 1.5 to 2.0 cm in length, was made to access the abdominal cavity. A multichannel port system was assembled with existing devices. Standard laparoscopic instruments were used to perform each cholecystectomy. Results: Patient demographics did not differ between the two groups. Of the eight cases that were converted to conventional laparoscopic surgery, seven were part of group I (P=0.063). Mean operation time for single‐port laparoscopic cholecystectomy was significantly shorter in group II (58.2 versus 71.6 min, P=0.004). There were two operative complications in group I, which were successfully managed with laparoscopic surgery. There was no statistical difference in occurrence of operative complication and hospital stay between the two groups. Conclusion: Single‐port laparoscopic cholecystectomy can be safely performed for various gallbladder lesions in selected cases, and the operation time improved with accumulation of cases.     

Single‐incision laparoscopic cholecystectomy for porcelain gallbladder: A case report

Single‐incision laparoscopic cholecystectomy (SILC) has been performed in patients with gallbladder stones without inflammation. Porcelain gallbladder is a rare finding of chronic cholecystitis that is characterized by extensive calcification of the gallbladder wall. Herein we describe our experience with SILC for porcelain gallbladder with a successful outcome. A 67‐old‐year woman was diagnosed with porcelain gallbladder. We performed SILC using a SILS Port and a 5‐mm forceps through the umbilical incision. Because a small amount of the omentum around the gallbladder was left to facilitate grasping the fundus, a view of both the cystic artery and the cystic duct was easily obtained. The operative time and the intraoperative blood loss were 66 min and less than 1 mL, respectively. The patient was discharged 3 days after surgery and was satisfied with the cosmetic results. Our procedure may represent an alternative to conventional laparoscopic cholecystectomy in patients with porcelain gallbladder.     

Single‐port endo‐laparoscopic surgery in combined abdominal procedures

Single‐port endo‐laparoscopic surgery has gained support in the surgical community because it is perceived to offer a better postoperative outcome as it requires only a single incision. We write this prospective observational study to ascertain the feasibility and safety of this technique in patients otherwise requiring two operations. Five patients who underwent double procedures with a single‐port device were reviewed: Case 1, a transabdominal preperitoneal hernia repair and gastric wedge resection; Case 2, cholecystectomy and diaphragmatic hernia repair; Case 3, oophorectomy and incisional hernia repair; Case 4, anterior resection of the rectum and hepatic segmentectomy; and Case 5, left adrenalectomy and cholecystectomy. Patient demographics, type of port used, operative time, complications and incision length were collected. Mean operative time for the cases ranged from 100 to 315 min. Incision length for the single‐port device was 2 cm. In Case 2, an additional 5‐mm port was used and an intraoperative complication involving a laceration of the liver occurred during the suturing of the gallbladder fundus. An additional 8‐cm lower abdominal incision (Pfannenstiel) was required in Case 4 to complete the colonic anastomosis and for specimen retrieval. Single‐port endo‐laparoscopic surgery is a feasible and safe technique for approaching double procedures. It drastically reduces the number of scars that a double procedure creates, and if difficulty arises, another port can always be added to ease the operation. It can also potentially reduce the number of admissions and anesthesia that a patient undergoes.     

Laparoscopic excision of abdominal wall desmoid tumor

Open surgical resection is the mainstay treatment for desmoid tumors. Laparoscopic resection is rarely used and not well described in the literature. We report a case of a single, 35‐year‐old woman who presented with palpable abdominal wall desmoid tumor. The patient had had laparoscopic cholecystectomy 2 years earlier, and the tumor was at the insertion site of the right upper quadrant trocar. The diagnosis was made by a Tru‐Cut biopsy at another institution, after the lesion had increased in size and caused increased discomfort. The patient underwent successful laparoscopic resection of the tumor. This report aimed to promote laparoscopic resection of abdominal wall desmoid tumors, whenever feasible, and describe the laparoscopic technique. We believe this is the second case of laparoscopic excision of desmoid tumor reported in the English‐language literature.     

意外胆囊癌12例诊治分析

目的总结意外胆囊癌的临床特点和治疗方法。方法回顾性分析重庆市第十三人民医院12例胆囊切除术中及术后发现的意外胆囊癌诊治情况。结果行胆囊切除术及胆道探查术10例,胆囊癌根治术2例,术后生存1年6例,生存2年及2年以上6例。结论意外胆囊癌术前诊断困难,应重视高危因素,手术是治疗胆囊癌的有效方法。     

微创胆囊切开取石术的临床评价

目的：评价微创胆囊切开取石术治疗胆囊结石的疗效。方法：回顾性分析158例行微创胆囊切开取石术的病人。并与同期所做开腹胆囊切除术376例及腹腔镜胆囊切除术188例进行比较，了解三种术式术后并发症情况。结果：158例行微创胆囊切开取石术的患者均痊愈出院，随访1-5年，结石复发28例（17.72%)。无症状复发23例，有症状复发5例。术后1，3，5年的分期复发率分别为1.9%(3/158),12.26%(13/106),17.91?2/67)。结果显示，微创胆囊切开取石术术后并发症发生率低于行开腹胆囊切除术和腹腔镜胆囊切除术的患者。结论：微创胆囊切开取石术治疗胆囊结石安全，有效，不应因过分强调结石复发而影响保胆手术的开展。     

Reduced‐port laparoscopic surgery for rectal cancer: Feasibility based on our early experience

We report our experience of a reduced‐port laparoscopic surgery as an advanced laparoscopic surgery for rectal cancer. Twelve selected patients with clinical T1–2 and N0 rectal cancer (clinical stage I) underwent low anterior resection of the rectum. The procedures were performed with one port plus a multiple‐instrument access port with three channels. The multiple‐instrument access port was placed at the umbilicus or the site of diverting stoma, and another port was placed in the right abdomen or in the opposite abdomen of ostomy. The median operative time and intraoperative bleeding were 280 min and 15 mL, respectively. The median number of harvested lymph nodes was 20. No major perioperative morbidities occurred in this series. The median postoperative hospital stay was 10 days. Low anterior resection performed by reduced‐port laparoscopic surgery is feasible as multiport laparoscopic surgery, and it is a reliable surgical option in selected patients with rectal cancer.     

Case of intra‐abdominal spindle cell tumor after laparoscopic resection of sigmoid colon cancer

We herein report a rare case of a patient who developed a spindle cell tumor at the inferior mesenteric artery clipping site. A 58‐year‐old man underwent laparoscopy‐assisted sigmoid colectomy for sigmoid colon cancer. As follow‐up, CT scans were performed every 6 months after the primary surgery. At the 1‐year CT, an nodular soft tissue density mass measuring 54 mm in diameter was found in the mesentery. Although we initially suspected locoregional recurrence of the colon cancer resected 1 year earlier, PET‐CT showed that the tumor was unrelated to the previous cancer. During the subsequent laparotomy, the mass appeared to originate from the inferior mesenteric artery clipping site, and it adhered to the jejunum and the left ureter. We completely resected the tumor and part of the jejunum, which we separated from the abdominal aorta and left ureter. The tumor was histologically diagnosed of a spindle cell tumor. The patient has been free from recurrence since the surgery more than 4.5 years ago. Preoperative PET‐CT was helpful in ruling out local recurrence of colon cancer, which might have made palliative care a better option than surgical resection.     

Single‐incision cholecystectomy in a patient with situs inversus totalis presenting with cholelithiasis: A case report

Laparoscopic cholecystectomy has become the gold standard for the treatment of cholelithiasis, and many reports of single‐incision laparoscopic cholecystectomy have been published in the past few years. Situs inversus totalis is a very rare condition, but the variant anatomy should not preclude a minimally invasive approach to surgery. We report a case of successful single‐port laparoscopic cholecystectomy in a patient with situs inversus totalis, describe the technical advantages, and review the literature.     

腹腔镜胆囊切除术中肝外胆道损伤的控制与预防

目的总结腹腔镜胆囊切除术中肝外胆道损伤的有效控制与预防措施。方法回顾性分析2000年1月至2006年12月本院行腹腔镜胆囊切除术的897例患者的完整资料,并对控制和预防肝外胆道损伤的效果进行分析。结果本研究中897例行腹腔镜胆囊切除术的患者中,早期进行的205例中有23例发生肝外胆管损伤,3例中转开腹;而2002年3月之后进行的692例无一发生肝外胆管损伤,也没有中转开腹。结论腹腔镜胆囊切除术中应熟悉胆囊管、胆囊颈的生理结构,根据胆囊的具体情况选择不同的手术方法,通过经验的累积可以减少腹腔镜胆囊切除术中肝外胆道损伤。     

Laparoscopic anterior resection for rectal cancer in a patient with a ventriculoperitoneal shunt

Laparoscopic surgery has been relatively contraindicated in patients with ventriculoperitoneal shunts (VPS) because of concerns about the effect of the pneumoperitoneum on shunt function. However, there have been recent reports of laparoscopic surgery on the gallbladder and cecum. This is the first report of laparoscopic high anterior resection for rectal cancer without manipulation of the VPS catheter in a patient with VPS. We made a diagnosis of advanced rectal cancer in a 77‐year‐old man who had a VPS to treat hydrocephalus after a subarachnoid hemorrhage. We performed the procedure with the patient in a 15° head‐down tilt and with 10‐mmHg pneumoperitoneum pressure. There were no postoperative complications. We concluded that laparoscopic surgery for rectal cancer can be safely performed in patients with VPS.     

血液透析患者的腹腔镜胆囊切除术

探讨和评价血液透析患者进行腹腔镜胆囊切除术的可行性和安全性。结果：所有患者术后２４ ～４８ｈ恢复血液透析。８ 例术后恢复良好，无任何并发症，１ 例出现胆囊三角区少量积液。结论：围手术期处理对血液透析患者相当重要，控制良好的血液透析患者可以安全进行腹腔镜胆囊切除术。     

58例腹腔镜手术切除复杂性胆囊临床分析

目的研究复杂性胆囊腹腔镜切除的手术处理技巧及安全性。方法对本院2008年8月~2010年9月收治的58例复杂性腹腔镜胆囊切除手术治疗病例进行回顾性分析。结果本组58例病例中1例中转开腹;其余病例均成功完成腹腔镜胆囊切除术无死亡病例。无胆管损伤及严重并发症病例。结论对于复杂性胆囊应重视B超,CT等辅助检查的评估,在正确的术式、熟练的操作以及灵活的技巧等前提下,腹腔镜手术切除复杂性胆囊的安全性毋庸置疑。     

Incidental detection of asymptomatic migration of Hem‐o‐lok clip into the bladder after laparoscopic radical prostatectomy

Hem‐o‐lok clips have been widely used in laparoscopic or robot‐assisted surgery. We report a case of an incidentally discovered Hem‐o‐lok migration into the bladder after laparoscopic radical prostatectomy. The patient was a 75‐year‐old man with localized prostate cancer who underwent laparoscopic radical prostatectomy in July 2009. At 3 postoperative years, follow‐up ultrasonography revealed a small round mass in the bladder. No lower urinary tract symptoms were reported, and urinalysis results had never indicated hematuria or pyuria. Cystoscopy revealed a Hem‐o‐lok clip in the bladder, near the vesicourethral anastomotic site. We could not remove it with forceps in the outpatient clinic, so we performed the procedure again under general anesthesia and successfully removed the Hem‐o‐lok clip. To our knowledge, this is the first report of an asymptomatic Hem‐o‐lok migration into the bladder.     

腹腔镜胆囊切除术中转开腹原因分析及防治

目的探讨腹腔镜胆囊切除（LC）术中转开腹原因及预防应对措施。方法回顾性分析句容市中医院2008年1月至2012年12月行LC术634例中中转开腹16例患者的临床资料。结果 16例中转开腹患者均痊愈出院,住院时间10-21 d,平均15.8 d。术后随访0.5-2年,无严重并发症发生,胆囊癌术后1年死亡。中转原因：炎性粘连9例,解剖变异2例,胆囊床广泛渗血1例,胆管损伤2例,胆囊癌1例,设备故障1例。结论严格掌握LC手术适应证,提高腹腔镜操作技术,把握中转开腹时机,可有效减少或避免并发症的发生。     

腹腔镜胆囊切除术转开腹的危险因素Logistic分析

目的 探讨腹腔镜胆囊切除术转开腹的主要危险因素.方法 回顾分析2009～2011年45例腹腔镜胆囊切除术中转开腹患者的临床资料,根据患者临床症状、体征以及临床指标对中转开腹的主要危险因素进行分析.结果 多因素Logistic回归结果显示,患者的胆囊壁厚度、胆囊炎发作次数、左上腹肌紧张程度、胆囊炎发作到手术时间、血清总胆红素、胆囊三角的清晰度以及墨菲征阳性程度均为胆囊切除术中转开腹的危险因素.结论 手术前对上述危险因素进行综合评估对成功施行腹腔镜胆囊切除术具有重要的临床指导意义.