Laparoscopic Cholecystectomy as Total Biopsy for Elevated Lesion of Gallbladder

Tohru Ichihara, Masumasa Horisawa, Natsuo Suzuki, Masanori Sekiya, Takanori matsui, Hoshiang Chen, Masato Kataoka, Hiroshi Miyagawa, Akihiko Koide, Shuh Ichihara*, Junichi Sakamoto**

The Department of Surgery and the Department of Pathology*, Nagoya National Hospital
The Department of Surgery, Aichi Prefectural Hospital**

Detection of gallbladder cancer in its early stage is still difficult in spite of the development of various diagnostic procedures. Due to its minimally invasive approach, laparoscopic cholecystectomy (LC) has been adopted internationally in the very short time since its introduction. To the best of our knowledge, however, few have applied this technique to the systematic diagnosis and treatment of elevated lesions of the gallbladder (ELG) of undetermined malignancy. When LC is performed as "total biopsy" of the gallbladder (GB) for ELG, the procedure becomes both diagnostic and therapeutic. Using this technique, we have experienced two patients with carcinoma of the GB out of 24 patients having ELG. One was limited to the mucosal layer (m) and the other showed invasion into the proper muscle layer (pm) as determined by intraoperative H-E frozen-section examination. In the latter case, an anomalous arrangement of the pancreato-biliary ductal system was found by direct intraoperative cholangiogram using a newly designed sheath with a round-tipped stylet. Therefore, the case was converted to open surgery, and the following additional operative procedures were performed: partial hepatectomy which included the GB bed and resection of the extra-hepatic bile duct and the extended dissection of the regional lymph nodes. ELG of undetermined maligancy under 20 mm in diameter is best treated by LC because we can obtain accurate and prompt pathological information about the disease, such as the degree of malignancy and invasion. In conclusion, LC may enable us to perform the most reasonable operative procedure for ELG, thereby avoiding insufficient or unnecessary extensive resection.

Key words
total biopsy of gallbladder, laparoscopic cholecystectomy, gallbladder cancer, elevated lesion of the gallbladder

Reprint requests
Tohru Ichihara Department of Surgery, Nagoya National Hospital
4-1-1 San-no-maru, Naka-ku, Nagoya, 460 JAPAN

Accepted
February 8, 1995

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