Eldo Ermenegildo Frezza1, Mitchell S Wachtel. 1. Department of Surgery, Division of General Surgery, Texas Tech University Health Sciences Center, MOP Building Suite 380, 3502 9th Street, Lubbock, TX 79415, USA. eldo.frezza@ttuhsc.edu
Abstract
INTRODUCTION: An animal model would be of great use to establish the safety and efficacy of laparoscopic hepatectomy. MATERIALS AND METHODS: A canine model of nonanatomic resection, using low pressure pneumoperitoneum, a variety of dissection and hemostatic techniques, and laparoscopic ultrasonographic vessel identification, was used. We used 20 female dogs: the first 10 were the training group, and the remaining 10 were the evaluation group. RESULTS: In the training group of 10 dogs, 3 of the first 4 developed pneumothorax; this was averted in subsequent cases by disconnecting the ventilator during establishment of pneumoperitoneum. During 2 weeks of postoperative evaluation, intraoperative bleeding required an extended procedure in 1 dog. No other dogs experienced massive intraoperative bleeding. Postoperatively, vital signs and blood hematocrit values showed no bleeding in any dog. Postoperatively, only 2 dogs, as measured by Jackson-Pratt drainage and serum total bilirubin levels, developed bile duct leakage; 1 died due to bacterial peritonitis. Serum aspartate aminotransferase levels corrected within 2 weeks. No emboli were observed in any of the dogs. CONCLUSION: A canine model of laparoscopic hepatectomy is feasible and has readily available monitors for major postoperative complications. Many patients with primary or secondary liver tumors would benefit from limited nonanatomic resection, which seems feasible as less-invasive techniques are improved.
INTRODUCTION: An animal model would be of great use to establish the safety and efficacy of laparoscopic hepatectomy. MATERIALS AND METHODS: A canine model of nonanatomic resection, using low pressure pneumoperitoneum, a variety of dissection and hemostatic techniques, and laparoscopic ultrasonographic vessel identification, was used. We used 20 female dogs: the first 10 were the training group, and the remaining 10 were the evaluation group. RESULTS: In the training group of 10 dogs, 3 of the first 4 developed pneumothorax; this was averted in subsequent cases by disconnecting the ventilator during establishment of pneumoperitoneum. During 2 weeks of postoperative evaluation, intraoperative bleeding required an extended procedure in 1 dog. No other dogs experienced massive intraoperative bleeding. Postoperatively, vital signs and blood hematocrit values showed no bleeding in any dog. Postoperatively, only 2 dogs, as measured by Jackson-Pratt drainage and serum total bilirubin levels, developed bile duct leakage; 1 died due to bacterial peritonitis. Serum aspartate aminotransferase levels corrected within 2 weeks. No emboli were observed in any of the dogs. CONCLUSION: A canine model of laparoscopic hepatectomy is feasible and has readily available monitors for major postoperative complications. Many patients with primary or secondary liver tumors would benefit from limited nonanatomic resection, which seems feasible as less-invasive techniques are improved.
Authors: Vincenzo Villani; Jordan D Bohnen; Radbeh Torabi; Francesco Sabbatino; David C Chang; Cristina R Ferrone Journal: HPB (Oxford) Date: 2016-04-26 Impact factor: 3.647