PMC7098343_01
a, b Contrast-enhanced computed tomography revealed a right renal tumor and gallbladder tumor of the neck. The enhanced gallbladder tumor did not invade into the hepatic parenchyma (arrow). c, d Magnetic resonance imaging of T2-weighted image revealed a clearly capsulized renal tumor of the right kidney, and magnetic resonance cholangiopancreatography also revealed the defect of the gallbladder neck (arrow).
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F1
An abdominal computed tomography workup revealed a right renal tumor about 4 cm in size and another tumor located from the body of the gallbladder to its neck (Fig. 1a, b). T2-weighted magnetic resonance imaging revealed the right renal tumor, and magnetic resonance cholangiopancreatography revealed a defect of the gallbladder neck (Fig. 1c, d).
Operative procedure. a The hilar Glissonean pedicle was taped to clamp the inflow from the proper hepatic artery without cystic artery flow. b Under ICG mode, the stained area of the hepatic parenchyma was marked by electrocautery to identify the perfusion area of the cystic vein. c Extended cholecystectomy was performed along the demarcation line. d We performed lymphadenectomy of the hepatoduodenal ligament. ICG, indocyanine green.
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F2
First, we encircled Calot's triangle using the Glissonean approach from the ventral side of the gallbladder plate, and then taped the hilar Glissonean pedicles to prevent inflow from the proper hepatic artery without cystic artery flow (Fig. 2a). The demarcation of stained areas within the hepatic parenchyma was marked by electrocautery to determine the transecting line (Fig. 2b). The gallbladder and the hepatic parenchyma of its bed were resected en bloc (Fig. 2c). Subsequently, we performed lymphadenectomy of the hepatoduodenal ligament (Fig. 2d), and the operation was complete.