Tricks of the Senior Surgeon

■ If the patient presents with a radiologic T3 or T4 gallbladder cancer, laparoscopic staging is warranted because of the high incidence of peritoneal metastases.

■ For surgical planning, any patient with a tumor in the neck of the gallbladder or in the cystic duct, or presenting with jaundice, should be scrutinized on preoperative scans for signs of right hepatic arterial involvement. If the right artery is encased, a minimum of an extended lobectomy is necessary for resection.

■ Accessory or replaced left hepatic arteries do not reside in the porta hepatis, but rather pass across the lesser omentum and enter the base of the umbilical fissure. Patients with these anomalous vessels can therefore often be resected even when extensive involvement of the porta exists.

■ Stay sutures should be placed before dividing the intrahepatic bile duct; otherwise the small segmental duct can slip away and retract within the liver parenchyma.

■ The lymphatic vessels throughout this dissection should be tied to prevent postoperative lymphorrhea.

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How to Stay Young

How to Stay Young

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