1st report of unexpected true left-sided gallbladder treated with robotic approach

INTRODUCTION: True left-sided gallbladder (T-LSG) occur when the gallbladder is positioned to the left of the ligamentum teres and falciform ligament and under the surface of the left liver lobe. PRESENTATION OF CASE: Patient is 29-year-old caucasian male, presenting with 9-month history of epigastric right upper quadrant (RUQ) colic pain. RUQ Ultrasound reported cholelithiasis, gallbladder wall thickening, and no intrahepatic biliary dilation. DISCUSSION: Robotic cholecystectomy was the chosen approach. When visceral surface of the liver was exposed, anomalous location of the gallbladder was noted, left to the round ligament. A cystic duct with a “hairpin” configuration and a very cephalad cystic artery were identified. Cholecystectomy was performed safely and uneventfully. CONCLUSION: No change of port setting was required with the robotic approach. The ICG-aided cholangiography improved surgeon’s ability to recognize the concomitant vascular and biliary anomalies. However, no definitive conclusion can be drown until further experience and volume are achieved.