An experimental teaching model for laparoscopic choledochojejunostomy

Abstract

For advanced laparoscopic procedures, team collaboration and good suturing skills are only two of many requirements to achieve success. Teaching opportunities are mandatory to allow general surgeons to become acquainted with advanced procedures and to gain confidence in new laparoscopic procedures. In this teaching model presented herein, the technical difficulties and operative steps of a laparoscopic choledochojejunostomy and drainage via Roux-en-Y-loop are outlined as performed on eight pigs weighing about 35 kg each (range, 31.2-41.2) with nondistended common bile ducts (5.6 mm; range, 4.2-6.3). Functionality of the bypass was assessed by a weekly monitoring of bilirubin levels and a contrast material injection into the gallbladder after a 4-month follow-up with measurements of the common bile duct (9.8 mm; range, 7.2-15.2) and the diameter of the choledochojejunostomy (5.0 mm; range, 3.6-6.2) at necropsy. This model provides outstanding conditions for teaching laparoscopic suture techniques to be applied in advanced laparoscopy and demonstrates the feasibility of laparoscopic choledochojejunostomy within a reasonable operation time (122 min; range, 105-155).