Ann Surg Treat Res.  2015 Jun;88(6):306-310. 10.4174/astr.2015.88.6.306.

In vivo porcine training model for laparoscopic Roux-en-Y choledochojejunostomy

• Lee JS
• Hong TH

• KMID: 1800643
• DOI: http://doi.org/10.4174/astr.2015.88.6.306

Abstract

PURPOSE
The purpose of this study was to develop a porcine training model for laparoscopic choledochojejunostomy (CJ) that can act as a bridge between simulation models and actual surgery for novice surgeons. The feasibility of this model was evaluated.
METHODS
Laparoscopic CJ using intracorporeal sutures was performed on ten animals by a surgical fellow with no experience in human laparoscopic CJ. A single layer of running sutures was placed in the posterior and anterior layers. Jejunojejunostomy was performed using a linear stapler, and the jejunal opening was closed using absorbable unidirectional sutures (V-Loc 180).
RESULTS
The average operation time was 131.3 +/- 36.4 minutes, and the CJ time was 57.5 +/- 18.4 minutes. Both the operation time and CJ time showed a steady decrease with an increasing number of cases. The average diameter of the CBD was 6.4 +/- 0.8 mm. Of a total of ten animals, eight were sacrificed after the procedure. In two animals, a survival model was evaluated. Both pigs recovered completely and survived for two weeks, after which both animals were sacrificed. None of the animals exhibited any signs of bile leakage or anastomosis site stricture.
CONCLUSION
The porcine training model introduced in this paper is an adequate model for practicing laparoscopic CJ. Human tissue simulation is excellent.

Keyword

Training model; Choledochojejunostomy; Laparoscopy

MeSH Terms

Animals
Bile
Choledochostomy*
Constriction, Pathologic
Humans
Laparoscopy
Running
Sutures
Swine

Figure

• 

  Fig. 1 Trocar placement and surgeon position during laparoscopic choledochojejunostomy (CJ). (A) Trocar placement. (B) Position of the surgeon during laparoscopic CJ.

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  Fig. 2 (A) Posterior wall suture of choledochojejunostomy. (B) Schematic illustration.

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  Fig. 3 Operative time by case number. Black bar: choledochojejunostomy time.

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