Invited Commentary

Professor Yamaguchi and his associates have evaluated the laparoscopic treatment of gallbladder carcinoma and propose that laparoscopic cholecystectomy is appropriate for the treatment of gallbladder carcinoma in situ and gallbladder carcinoma not invading through to the serosa. The problems associated with performing laparoscopy in patients with intraperitoneal malignancy are well recognized and include possible port site implantation and intraperitoneal dissemination and implantation. The implantation process seems to be unique to laparoscopic treatment in several ways. The development of recurrent cancer in abdominal scars following oncologic procedures performed through a laparotomy incision is unusual and, like breast cancer recurrence in mastectomy incisions, generally represents systemic dissemination of the disease. Laparoscopy produces port site recurrence in the absence of disseminated disease, and the implantation can become clinically evident virtually within days of the laparoscopic procedure. Intraperitoneal dissemination and seeding is uncommon in the natural history of gallbladder carcinoma. Laparoscopy has produced seeding