Abstract
BackgroundThe transcystic approach to laparoscopic common bile duct exploration has gained popularity for the single-stage management of choledocholithiasis with concomitant gallstones. Our team previously described the use of a porcine aorta segment to simulate the common bile duct during laparoscopic skill training.MethodsWith the advent of the transcystic approach as a contender for the first-line technique of accessing the common bile duct, we present an evolution of the laparoscopic training model using a Porcine Aorta-Renal Artery (PARA) specimen to simulate the structural integrity, dimensions and spatial distribution of both the human cystic and common bile ducts.ResultsThis training model allows the use of a choledochoscope for transcystic exploration of the biliary tree. It combines fidelity and reproducibility required for a simulated training model to offer experience in laparoscopic transcystic common bile duct exploration. Validation of the model was demonstrated by 21 surgeons who completed a questionnaire after performing the simulated procedure. In all sections assessing reliability, face validity and content validity of the model, mean rating scores were between 4 and 5 out of five (good or excellent).ConclusionsWe present the evolution of an established training model for laparoscopic common bile duct exploration which focusses the attention on the transcystic approach to the common bile duct and the use of lithotripsy techniques. The need for such a model reflects the shift in the current practice of the laparoendoscopic management of choledocholithiasis with concomitant gallstones from transductal to transcystic approach.
Highlights
Clearance of common bile duct (CBD) stones by laparoscopic common bile duct exploration (LCBDE) at the time of cholecystectomy is the preferred treatment for choledocholithiasis with concomitant gallstones, provided that the necessary expertise are available [1]
With the advent of the transcystic approach as a contender for the first-line technique in CBD exploration, we present an evolution of the laparoscopic training model using an animal specimen that would include the porcine aorta and the right renal artery to mimic the cystic duct
How reproducible do you think this model is? How realistic do you think this model is? How appropriate do you think this model is as a teaching modality? After using this model, how confident are you in performing transcystic LCBDE in a live patient?
Summary
With the advent of the transcystic approach as a contender for the first-line technique of accessing the common bile duct, we present an evolution of the laparoscopic training model using a Porcine Aorta-Renal Artery (PARA) specimen to simulate the structural integrity, dimensions and spatial distribution of both the human cystic and common bile ducts
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