A New Teaching Model for Laparoscopic Common Bile Duct Exploration: Use of Porcine Aorta

Navarro‐Sánchez, Antonio; Roon, Alexander C. von; Thomas, Rhys; Marchington, Stephen Windsor; Isla, Alberto

doi:10.1016/j.cireng.2013.02.018

Cited by 2 publications

(1 citation statement)

References 3 publications

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“…Navarro-Sanchez et al 28 used a porcine aorta model concluding that although live animal models provided the most realistic experience they were expensive and raised ethical and regulatory issues. However, their model could not reproduce realistic transcystic choledochoscopy, or simulate intrahepatic duct anatomy or the WBM.…”

Section: Discussionmentioning

confidence: 99%

Utilization of Laparoscopic Choledochoscopy During Bile Duct Exploration and Evaluation of the Wiper Blade Maneuver for Transcystic Intrahepatic Access

Nassar

Gough

et al. 2023

Annals of Surgery

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Objective: This study aims to examine the indications, techniques, and outcomes of choledochoscopy during laparoscopic bile duct exploration and evaluate the results of the wiper blade maneuver (WBM) for transcystic intrahepatic choledochoscopy. Summary of Background Data: Choledochoscopy has traditionally been integral to bile duct explorations. However, laparoscopic era studies have reported wide variations in choledochoscopy availability and use, particularly with the increasing role of transcystic exploration. Methods: The indications, techniques, and operative and postoperative data on choledochoscopy collected prospectively during transcystic and choledo-chotomy explorations were analyzed. The success rates of the WBM were evaluated for the 3 mm and 5 mm choledochoscopes. Results: Of 935 choledochoscopies, 4 were performed during laparoscopic cholecystectomies and 931 during 1320 bile duct explorations (70.5%); 486 transcystic choledochoscopies (52%) and 445 through choledochotomies (48%). Transcystic choledochoscopy was utilized more often than blind exploration (55.7%% vs 44.3%) in patients with emergency admissions, jaundice, dilated bile ducts on preoperative imaging, wide cystic ducts, and large, numerous or impacted bile duct stones. Intrahepatic choledochoscopy was successful in 70% using the 3 mm scope and 81% with the 5 mm scope. Choledochoscopy was necessary in all 124 explorations for impacted stones. Twenty retained stones (2.1%) were encountered but no choledochoscopy related complications. Conclusions: Choledochoscopy should always be performed during a chol-edochotomy, particularly with multiple and intrahepatic stones, reducing the incidence of retained stones. Transcystic choledochoscopy was utilized in over 50% of explorations, increasing their rate of success. When attempted, the transcystic WBM achieves intrahepatic access in 70%-80%. It should be part of the training curriculum.

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Section: Discussionmentioning

confidence: 99%