James O Brewer1, Lalin Navaratne1,2, Stephen W Marchington3, David Martínez Cecilia4, Jose Quiñones Sampedro5, Luis Muñoz Bellvis5, Alberto Martínez Isla6,7. 1. Department of Upper Gastrointestinal Surgery, Northwick Park Hospital, London North West University Healthcare NHS Trust, Watford Road, Harrow, London, HA1 3UJ, UK. 2. Defence Medical Services, Birmingham, UK. 3. Department of Surgery and Cancer, Imperial College London, London, UK. 4. Hospital Universitario de Toledo, Toledo, Spain. 5. Hospital Universitario de Salamanca, Salamanca, Spain. 6. Department of Upper Gastrointestinal Surgery, Northwick Park Hospital, London North West University Healthcare NHS Trust, Watford Road, Harrow, London, HA1 3UJ, UK. a.isla@imperial.ac.uk. 7. Department of Surgery and Cancer, Imperial College London, London, UK. a.isla@imperial.ac.uk.
Abstract
BACKGROUND: The 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. METHODS: 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. RESULTS: This 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). CONCLUSIONS: We 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.
BACKGROUND: The 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. METHODS: 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. RESULTS: This 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). CONCLUSIONS: We 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.
Entities:
Keywords:
Choledocholithiasis; Common bile duct stones; Laparoscopic common bile duct exploration; Laparoscopic transcystic common bile duct exploration; Porcine Aorta-Renal Artery model
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