EURASIAN EXPERIMENT JOURNAL OF PUBLIC HEALTH

(EEJPH) ISSN: 2992-4081

©EEJPH Publications Volume 4 Issue 1 2023
Page | 8
The role of minimally invasive surgery in gallbladder
carcinoma

*
Emmanuel Ifeanyi Obeagu1 and Getrude Uzoma Obeagu2

1
Department of Medical Laboratory Science, Kampala International
University, Uganda.
2
School of Nursing Science, Kampala International University, Uganda.
1
ORCID0000-0002-4538-0161
1
Email:emmanuelobeagu@yahoo.com

ABSTRACT
Gallbladder carcinoma is a malignant tumor that originates from the cells lining the gallbladder. It is a relatively
rare form of cancer but is associated with a poor prognosis due to its aggressive nature and late-stage diagnosis. The
incidence of gallbladder carcinoma varies geographically. Minimally invasive surgery, also known as minimally
invasive techniques or laparoscopic surgery, is a modern surgical approach that aims to achieve therapeutic goals
while minimizing surgical trauma and invasiveness. It involves utilizing specialized instruments and advanced
technologies to perform surgical procedures through small incisions or natural body openings.
Keywords:Gallbladder, carcinoma, gallbladder carcinoma, minimally invasive surgery.

INTRODUCTION
Gallbladder carcinoma refers to the development of malignant tumors in the gallbladder, a small pear-shaped organ
located beneath the liver. It is the most common malignancy of the biliary tract, although it remains a relatively rare
form of cancer worldwide [1-5]. Gallbladder carcinoma arises from the epithelial cells that line the inner surface of
the gallbladder. The exact causes of gallbladder carcinoma are not fully understood, but several risk factors have
been identified. The most significant risk factor is the presence of gallstones, which is believed to contribute to
chronic inflammation of the gallbladder and increase the risk of developing cancer over time other risk factors
include chronic infection of the gallbladder, obesity, advanced age, female gender, and certain genetic conditions
[6]. Gallbladder carcinoma poses significant challenges in terms of diagnosis, treatment, and patient outcomes. The
disease is often asymptomatic in its early stages, leading to delayed detection and poor prognosis a higher likelihood
of advanced disease at the time of diagnosis. As the tumor grows, it can cause various symptoms such as abdominal
pain, jaundice, weight loss, loss of appetite, nausea, and vomiting [7].
Gallbladder carcinoma
Gallbladder carcinoma, also known as gallbladder cancer, is a malignant tumor that develops in the tissues lining
the gallbladder. Gallbladder carcinoma is a relatively rare form of cancer. Gallbladder carcinoma is more commonly
diagnosed in females than males, and it typically affects individuals in their 60s and 70s. The diagnosis of gallbladder
carcinoma typically involves a combination of imaging studies and histopathological examination. Imaging
modalities such as ultrasound, computed tomography (CT), magnetic resonance imaging (MRI), and positron
emission tomography (PET) scans are used to visualize the gallbladder and surrounding structures, assess the extent
of the tumor, and detect any potential spread to nearby lymph nodes or distant organs [8]. Confirmation of the
©Obeagu and Obeagu, 2023
This is an Open Access article distributed under the terms of the Creative Commons Attribution License
(http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in
any medium, provided the original work is properly cited.
diagnosis is obtained through tissue biopsy, where a sample of the tumor is taken and analyzed by a pathologist
under a microscope. This allows for the determination of the histological type and grade of the cancer, which helps
guide treatment decisions.
The prognosis of gallbladder carcinoma is generally poor, primarily due to late-stage diagnosis and the aggressive
nature of the disease. The treatment approach depends on several factors, including the stage of the cancer, the
overall health of the patient, and the patient's preferences. Surgical resection of the gallbladder, known as
cholecystectomy, is the mainstay of treatment for localized disease. However, advanced cases may require a more Page | 9
extensive surgical procedure, such as removing a portion of the liver or nearby lymph nodes.
In addition to surgery, other treatment modalities may be employed, such as chemotherapy, radiation therapy,
targeted therapy, and immunotherapy. These treatments aim to eradicate remaining cancer cells, control the disease,
and improve overall survival [9]. The management of gallbladder carcinoma requires a multidisciplinary approach
involving surgeons, medical oncologists, radiation oncologists, pathologists, and other healthcare professionals.
Close monitoring, regular follow-up visits, and ongoing surveillance are essential to detect any recurrence or
metastasis early and intervene promptly.
Several risk factors have been associated with the development of gallbladder carcinoma. These include:
Gallstones: Gallbladder stones, particularly large or calcified stones, increase the risk of developing gallbladder
carcinoma.
Chronic inflammation: Conditions that cause chronic inflammation of the gallbladder, such as chronic cholecystitis
or gallbladder polyps, are associated with an increased risk.
Obesity: Obesity, along with metabolic syndrome, has been identified as a risk factor for gallbladder carcinoma.
Ethnicity: Certain ethnic groups, such as Native Americans and Hispanics, have a higher incidence of gallbladder
carcinoma.
Genetic predisposition: Certain genetic mutations, such as alterations in the TP53 and KRAS genes, have been
implicated in the development of gallbladder carcinoma.
Gallbladder carcinoma is often asymptomatic in its early stages, which contributes to the challenges of early
detection. As the tumor grows and progresses, various symptoms may manifest, including:
Abdominal pain: Persistent abdominal pain, typically located in the upper right quadrant, is a common symptom
of gallbladder carcinoma.
Jaundice: Obstruction of the bile ducts by the tumor can lead to jaundice, characterized by yellowing of the skin
and eyes.
Weight loss: Unexplained weight loss is a frequent symptom in advanced stages of gallbladder carcinoma [10].

Minimally Invasive Surgical Techniques

Minimally invasive surgical techniques, including laparoscopic surgery and robotic surgery, have emerged as viable
alternatives to traditional open surgery for the treatment of gallbladder carcinoma. These techniques utilize smaller
incisions and specialized instruments to perform the surgical procedure, offering several advantages over open
surgery [11].
Laparoscopic Surgery: is a minimally invasive technique that involves the use of a laparoscope, a thin, flexible tube
with a camera and light source, inserted through small incisions in the abdomen. The surgeon visualizes the surgical
field on a monitor and manipulates specialized instruments inserted through additional small incisions to perform
the procedure. Some key aspects of laparoscopic surgery for gallbladder carcinoma include:
Trocar placement: Several small incisions, typically ranging from 0.5 to 1.5 cm, are made in the abdomen to insert
trocars, which serve as access points for the laparoscope and instruments.
Dissection and removal: The gallbladder is dissected and removed using specialized laparoscopic instruments. The
surgeon carefully separates the gallbladder from surrounding tissues, ensuring complete removal while preserving
nearby structures.
Lymph node dissection: If necessary, lymph nodes in the region are also removed using laparoscopic techniques to
assess the extent of tumor involvement and aid in staging.
Closure: After the gallbladder and lymph node dissection, the small incisions are closed, often with absorbable
sutures or surgical glue.
Robotic Surgery: Robotic surgery is an advanced form of minimally invasive surgery that utilizes a robotic system
to enhance surgical precision and dexterity. The surgeon controls robotic arms equipped with instruments from a
console, while the robotic system translates their movements into precise actions within the patient's body. Some
key features of robotic surgery for gallbladder carcinoma include:

©Obeagu and Obeagu, 2023

This is an Open Access article distributed under the terms of the Creative Commons Attribution License
(http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in
any medium, provided the original work is properly cited.
Robotic console: The surgeon sits at a console located in the operating room, controlling the robotic arms and
instruments with hand and foot controls.
3D visualization: The robotic system provides a three-dimensional high-definition view of the surgical field,
offering enhanced depth perception and visualization compared to traditional laparoscopy.
Instrument articulation: The robotic instruments have enhanced articulation capabilities, mimicking the
movements of the surgeon's hands with greater precision and range of motion.
Ergonomics: The surgeon operates from a seated position, experiencing reduced physical strain compared to Page | 10
traditional laparoscopy, which can lead to enhanced surgical performance and reduced fatigue.
Safety of Minimally Invasive Surgery in Gallbladder Carcinoma
The safety of minimally invasive surgery (MIS) in gallbladder carcinoma is a critical aspect that needs to be carefully
evaluated. While MIS techniques, such as laparoscopic and robotic surgery, offer several advantages over traditional
open surgery, it is essential to consider the potential risks and ensure patient safety [12].
Surgical Outcomes: Numerous studies have assessed the safety of MIS in gallbladder carcinoma and have reported
comparable surgical outcomes to open surgery in terms of postoperative complications, surgical margins, and long-
term survival. However, it is important to note that the safety of MIS can vary depending on tumor characteristics,
stage, and surgeon expertise.
Conversion to Open Surgery: One important safety consideration in MIS for gallbladder carcinoma is the
possibility of conversion to open surgery. Conversion to open surgery may be necessary if technical difficulties are
encountered, such as extensive tumor invasion, inability to achieve adequate resection margins, or intraoperative
complications. The conversion rate to open surgery for gallbladder carcinoma has been reported in various studies
to range from 5% to 30%.
Intraoperative Complications: Intraoperative complications can occur during MIS for gallbladder carcinoma,
similar to open surgery. These may include bleeding, bile duct injury, and injury to surrounding structures.
However, with experienced surgeons and careful technique, the incidence of intraoperative complications is
generally low.
Postoperative Complications: Postoperative complications are a concern in any surgical procedure, including MIS
for gallbladder carcinoma. Common complications include surgical site infections, bile leaks, bile duct strictures, and
wound complications. The overall incidence of postoperative complications in MIS is generally comparable to or
slightly lower than that of open surgery. However, specific patient factors and tumor characteristics can influence
the risk of complications.
Learning Curve: The safety of MIS in gallbladder carcinoma is closely tied to the surgeon's experience and
expertise. Studies have demonstrated that there is a learning curve associated with MIS techniques, particularly
with regard to achieving adequate lymph node dissection and ensuring complete tumor resection. Surgeons with
greater experience in MIS tend to have lower rates of complications and better surgical outcomes [13].
Patient Selection: Proper patient selection is crucial for ensuring the safety of MIS in gallbladder carcinoma.
Patients with advanced-stage disease, extensive tumor invasion, or significant comorbidities may not be suitable
candidates for MIS and may require open surgery for optimal oncological outcomes and patient safety.
Oncological Outcomes of Minimally Invasive Surgery
The oncological outcomes of minimally invasive surgery (MIS) in gallbladder carcinoma are a crucial aspect to
consider when evaluating the effectiveness of these techniques. While MIS approaches, such as laparoscopic and
robotic surgery, offer potential benefits in terms of reduced postoperative morbidity and faster recovery, it is
essential to ensure that these techniques achieve comparable oncological outcomes to traditional open surgery [14].
Radical Resection: One of the primary goals in the surgical treatment of gallbladder carcinoma is achieving a
radical resection, which involves complete removal of the tumor with negative surgical margins. Studies evaluating
the oncological outcomes of MIS in gallbladder carcinoma have reported rates of radical resection comparable to
those of open surgery. The adequacy of surgical margins in MIS is determined by careful dissection and meticulous
attention to detail during the procedure.
Lymph Node Dissection: Lymph node involvement is an important prognostic factor in gallbladder carcinoma.
Adequate lymph node dissection is necessary to accurately stage the disease and guide further treatment decisions.
Studies have shown that MIS techniques can achieve lymph node retrieval and dissection comparable to open
surgery. Proper lymph node assessment aids in determining the extent of disease and helps guide adjuvant therapy,
if necessary.
Survival Rates: are critical indicators of the effectiveness of any surgical treatment for gallbladder carcinoma.
Several studies have assessed the long-term survival outcomes of MIS in gallbladder carcinoma and have

©Obeagu and Obeagu, 2023

This is an Open Access article distributed under the terms of the Creative Commons Attribution License
(http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in
any medium, provided the original work is properly cited.
demonstrated comparable overall survival and disease-free survival rates to open surgery. These findings suggest
that MIS techniques, when performed by experienced surgeons with appropriate patient selection, can achieve
similar oncological outcomes.
Recurrence Rates: are important considerations in evaluating the effectiveness of surgical treatment. Studies
comparing MIS to open surgery for gallbladder carcinoma have reported similar rates of local recurrence and distant
metastasis between the two approaches. Proper patient selection, meticulous surgical technique, and careful follow-
up are essential in minimizing the risk of recurrence and improving long-term outcomes. Page | 11
Quality of Surgical Resection: The quality of surgical resection, including the completeness of tumor removal and
the absence of residual disease, is crucial in achieving optimal oncological outcomes. Studies have shown that MIS
techniques can achieve comparable rates of R0 resection (no residual tumor) to open surgery in gallbladder
carcinoma [15].
Biliary obstruction management: Minimally invasive techniques can be employed for palliative interventions in
patients with advanced gallbladder carcinoma. These interventions include the placement of biliary stents to relieve
obstructive jaundice and improve quality of life.
Reduced morbidity: Minimally invasive palliative procedures offer decreased morbidity compared to open
procedures. They are associated with lower rates of complications, shorter hospital stays, and faster recovery,
thereby improving patient comfort and well-being [16].
CONCLUSION
The utilization of minimally invasive surgery (MIS) techniques, including laparoscopic and robotic surgery, in the
management of gallbladder carcinoma shows promise and offers several potential advantages. It suggests that MIS
can achieve comparable surgical outcomes, including radical resection, lymph node dissection, and oncological
outcomes, when compared to traditional open surgery.
REFERENCES
1. Mishra R, Goda C, Arora M, Sood M, Siddiqui AA, Husain A, Rashid M, Mishra S. Treatment of Gall
Bladder Cancer: A Review. Indo Global J Pharm Sci. 2011; 2:54-62.
2. Obeagu EI, Katya MC. A Systematic Review on Physiological Jaundice: Diagnosis and Management of The
Affected Neonates. Madonna University journal of Medicine and Health Sciences, 2022;2(3):25-41.
3. Umoke CI, Umoke CC, Orieji P, Madukwe J, Bunu UO, Obeagu EI. The demonstration of expressed
microsatelite protein (MLH1) on colorectal carcinoma tissue. Int. J. Adv. Res. Biol. Sci. 2023;10(3):144-50.
4. Obeagu EI. An update on susceptibility of individuals to diseases based on ABO blood groups. Int. J. Curr.
Res. Med. Sci. 2019;5(3):1-8.
5. Obeagu EI, Obeagu GU. Occult Hepatitis B infection and immunity. Int. J. Curr. Res. Med. Sci.
2017;3(8):89-100.
6. Hundal R, Shaffer EA. Gallbladder cancer: Epidemiology and outcome. Clin Epidemiol. 2014.
7. Reid KM, Ramos-De la Medina A, Donohue JH. Diagnosis and surgical management of gallbladder cancer:
a review. Journal of gastrointestinal surgery. 2007; 11:671-81.
8. Xu, T., & Liu, Y. (2017). Minimally invasive surgical techniques for gallbladder carcinoma: A systematic
review. World Journal of Surgical Oncology, 15(1): 120.
9. Zhao L, Xu J. Advances in the treatment of gallbladder carcinoma: A literature review. Cancer Management
and Research, 2018; 10, 1213-1225.
10. Sheth S, Bedford A, Chopra S. Primary gallbladder cancer: recognition of risk factors and the role of
prophylactic cholecystectomy. American Journal of Gastroenterology, 2000; 95(6), 1402-1410.
11. Fuchs KH. Minimally invasive surgery. Endoscopy. 2002;34(02):154-9.
12. Kang CM, Kim KS. Safety of laparoscopic approach for gallbladder carcinoma: An updated meta-analysis
of observational studies. Surgical Oncology, 2020; 35, 200-206.
13. Liu F, Wu ZR, Hu HJ, Jin YW, Ma WJ, Wang JK, Li FY. Current status and future perspectives of
minimally invasive surgery in gallbladder carcinoma. ANZ Journal of Surgery. 2021;91(3):264-8.
14. Jin J, Wang F, Zhao Z, Liu S. Minimally invasive surgery versus open surgery in the treatment of
gallbladder cancer: A systematic review and meta-analysis. Oncotargets and Therapy, 2019; 12, 10847-
10859.
15. Sun J, Xie TG, Ma ZY, Wu X, Li BL. Current status and progress in laparoscopic surgery for gallbladder
carcinoma. World Journal of Gastroenterology. 2023; 29(16):2369.
16. Huisman ER, Morales E, van Hoof J, Kort HS. Healing environment: A review of the impact of physical
environmental factors on users. Building and environment. 2012; 1; 58:70-80.

©Obeagu and Obeagu, 2023

This is an Open Access article distributed under the terms of the Creative Commons Attribution License
(http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in
any medium, provided the original work is properly cited.
 Page | 12

©Obeagu and Obeagu, 2023

This is an Open Access article distributed under the terms of the Creative Commons Attribution License
(http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in
any medium, provided the original work is properly cited.