Robotic Cholecystectomy for Porcelain Gallbladder and a 6.8-cm Stone
Rushin D. Brahmbhatt, MD
Penn State Health Milton S. Hershey Medical Center

The incidence of porcelain gallbladder is low but carries a potential risk of malignancy. Large gallstones pose technical obstacles for minimally invasive surgical procedures. In this case, a 72-year-old woman undergoes a robotic cholecystectomy because of her porcelain gallbladder and a 6.8-cm gallstone. The surgical procedure involved appropriately addressing two major concerns: obtaining sufficient gallbladder retraction because of the large size of the stone, and the presence of hepatic steatosis. Key modifications included strategic port placement, utilizing stone position for retraction, and early cystic artery division. The procedure finished without any issues. The frozen section analysis results showed benign pathology. The patient recovered from surgery without any complications. Key takeaways are that robotic cholecystectomy can be safely performed for a porcelain gallbladder with large gallstones using appropriate technical modifications, and that flexibility in the operating room is crucial in cases where standard methods become impractical.