Highlights
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Cholecystectomy at the time of open cytoreductive surgery for ovarian cancer is safe and feasible.
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Clear visualization of the structures of the hepatocystic triangle is essential to ensure safety during cholecystectomy.
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Anatomic variants to the biliary system are common, and knowledge of these variants is important avoid inadvertent injury.
Abstract
Introduction
We sought to demonstrate a method of performing open cholecystectomy at the time of cytoreductive surgery for ovarian cancer.
Case/Methods
In this surgical film, we present the case of a 78-year-old woman with metastatic high-grade serous ovarian cancer who underwent primary cytoreductive surgery at Memorial Sloan Kettering Cancer Center (New York, NY). The surgery was recorded via video, and important steps of performing a cholecystectomy were highlighted. The indications for cytoreductive surgery and cholecystectomy were discussed. Right upper quadrant anatomy was reviewed, including key anatomic variants that can lead to inadvertent injury during dissection. The critical view of safety was emphasized, highlighting the requirement of clear visualization of the structures of the hepatocystic triangle (Strasberg et al., 1995, Strasberg and Brunt, 2010, Manatakis, 2023). Key considerations in identifying, isolating, and ligating the cystic artery and duct were reviewed. Perioperative outcomes were summarized.
Conclusion
Performance of cholecystectomy at the time of cytoreductive surgery for advanced ovarian cancer is safe and feasible (Son, 2023). Anatomic variants to the biliary system are common, and it is important to be vigilant of the location and course of key structures to avoid inadvertent injury.
1. Consent statement
The patient provided verbal consent to allow the authors to prepare and publish the surgical film.
Funding
This research was funded in part by the National Institutes of Health/National Cancer Institute Cancer Center Support Grant P30 CA008748.
CRediT authorship contribution statement
Lindsey Finch: Writing – original draft, Project administration, Methodology, Conceptualization. Danyal Ahsan Muhammad: Writing – review & editing, Project administration, Investigation. Dennis S. Chi: Writing – review & editing, Project administration, Methodology, Conceptualization, Supervision.
Declaration of Competing Interest
The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: DS Chi reports personal fees from Apyx Medical, Verthermia Inc., Biom 'Up, and AstraZeneca, as well as recent or current stock/options ownership of Apyx Medical, Verthemia, Intuitive Surgical, Inc., TransEnterix, Inc., Doximity, Moderna, and BioNTech SE. The other authors do not have potential conflicts of interest to declare.
Footnotes
Supplementary data to this article can be found online at https://doi.org/10.1016/j.gore.2024.101369.
Appendix A. Supplementary data
The following are the Supplementary data to this article:
References
- Manatakis D.K., et al. Critical view of safety in laparoscopic cholecystectomy: a systematic review of current evidence and future perspectives. World J. Surg. 2023;47(3):640–648. doi: 10.1007/s00268-022-06842-0. [DOI] [PubMed] [Google Scholar]
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