Robotic Approach for Regional Lymphadenectomy and Liver Bisegmentectomy in Gallbladder Cancer

Gallbladder cancer (GBC) is an aggressive malignancy with poor prognosis. Due to the generally asymptomatic course of the disease in its early stages, patients are most often diagnosed incidentally (iGBC), following cholecystectomy for presumed benign disease. Thorough staging to predict oncologic and technical resectability is mandatory. Robotic surgery has emerged as a promising approach for the treatment of complex hepatic malignancies, and it can be performed in almost all types of liver resections. However, due to limited data, the minimally invasive approach in GBC remains controversial. Positive regional lymph nodes (LNs) and therefore the quality of lymphadenectomy have been proven to be significant predictors of survival after surgery. This study aims to report our approach for regional lymphadenectomy and robotic liver resection (RLR) in patients with GBC or iGBC diagnosed after laparoscopic cholecystectomy (LC), focusing on the surgical technique, adequacy of regional lymphadenectomy and outcomes.