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Page 8 of 11 Sullivan et al. Mini-invasive Surg 2023;7:15 https://dx.doi.org/10.20517/2574-1225.2022.106

Table 4. Studies evaluating endoscopic gallbladder polyp management
Authors Technique n Outcomes
Wang et al. [72] Combined lap and endo, with lap cholecystotomy and endo polypectomy 60 93% technical success with no polyp
recurrence at 3 months
[74]
Shen et al. EUS guided cholecystostomy with metal stent placement, followed by second 4 1 patient with pancreatitis, 1 patient
endo gallbladder polypectomy underwent LC for gallstones, no polyp
recurrence
Zheng et al. [73] Combined lap and endo with laparoscopy used to identify and incise 1 Operative time 96 min with EBL of 10 mL
gallbladder, followed by transumbilical endo electroresection, and lap suture
of gallbladder
[75]
Zhang et al. Endo gastrotomy to allow endoscope into peritoneum followed by endo 22 4 patients with localized peritonitis,
incision in gallbladder for access to polypectomy, endoloop and clips to close median LOS 5 days, 1 recurrent gallstone
both
He et al. [76] E-NOTES: insertion of endoscope via 10 mm umbilical trochar to incise 12 No recurrence of polyps at 12 months
gallbladder, perform polypectomy, and close gallbladder with clips
Endo: Endoscopic; EUS: endoscopic ultrasound; EBL: estimated blood loss; E-NOTES: embryonic-natural orifice transumbilical endoscopic surgery;
Lap: laparoscopic; LC: laparoscopic cholecystectomy; LOS: length of stay.

and only patients with very low risk of cancer are appropriate for these techniques as they involve
cholecystotomy and significant risk of bile spillage which would worsen survival in the event a cancerous
polyp was discovered. The endoscopic techniques summarized in Table 4 nonetheless represent continued
advancement and innovation toward increasingly minimally invasive and organ-sparing treatment of
gallbladder polyps.

CONCLUSION
Gallbladder polyps are occasionally encountered on abdominal US, given the overall common incidence of
cholelithiasis. A minimally invasive strategy for managing gallbladder polyps not only aims to minimize
procedural morbidity but also balances the overall low risk of either harboring or developing into
gallbladder cancer, with a high rate of mortality from gallbladder cancer when diagnosed at later stages. In
select low-risk patients, no follow-up or US follow-up is appropriate. When cholecystectomy is indicated,
laparoscopic cholecystectomy is preferred and single port or single incision laparoscopic surgery has been
used for gallbladder polyps as well with acceptable results. In addition to laparoscopic surgery, robotic
surgery has advantages that include wrist motion of the instruments and 3D visualization from the camera,
and potential benefits include future technological advances in indocyanine green (ICG) fluorescence,
artificial intelligence, or augmented reality applications to the robotic platform. Laparoscopic and robotic
surgery not only has benefits over open surgery with respect to short-term outcomes, but also appears to be
oncologically safe in the event that either an early cancer that can be treated with cholecystectomy alone is
encountered, or in the event a more radical resection is required in experienced centers. Finally, several
authors have attempted gallbladder sparing polypectomies using either combined endoscopic/laparoscopic
or purely endoscopic techniques for benign gallbladder polyps to further reduce the invasiveness of the
management of gallbladder polyps. Small retrospective studies appear to demonstrate some safety and
feasibility of these techniques in select patients with polyps without a high risk of harboring cancer;
however, more evidence is required before broad adoption of these approaches over the standard
laparoscopic or robotic cholecystectomy.

DECLARATIONS
Authors’ contributions
Literature review, writing manuscript, editing and review: Sullivan KM, Fong Y