Robotic-assisted laparoscopic Roux-en-Y choledochojejunostomy in pigs

PurposeThe purpose of this study was to develop a porcine training model for laparoscopic choledochojejunostomy (CJ) that can act as a bridge between simulation models and actual surgery for novice surgeons. The feasibility of this model was evaluated.MethodsLaparoscopic CJ using intracorporeal sutures was performed on ten animals by a surgical fellow with no experience in human laparoscopic CJ. A single layer of running sutures was placed in the posterior and anterior layers. Jejunojejunostomy was performed using a linear stapler, and the jejunal opening was closed using absorbable unidirectional sutures (V-Loc 180).ResultsThe average operation time was 131.3 ± 36.4 minutes, and the CJ time was 57.5 ± 18.4 minutes. Both the operation time and CJ time showed a steady decrease with an increasing number of cases. The average diameter of the CBD was 6.4 ± 0.8 mm. Of a total of ten animals, eight were sacrificed after the procedure. In two animals, a survival model was evaluated. Both pigs recovered completely and survived for two weeks, after which both animals were sacrificed. None of the animals exhibited any signs of bile leakage or anastomosis site stricture.ConclusionThe porcine training model introduced in this paper is an adequate model for practicing laparoscopic CJ. Human tissue simulation is excellent.

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“…Since the advent of robotic surgery, animal models using the robot have been developed [ 13 , 14 ]. Both papers described end to side CJ.…”

Section: Discussionmentioning

confidence: 99%

“…Both papers described end to side CJ. One article described CJ using running sutures for both the posterior layer and the anterior layer [ 14 ], and the other described CJ using interrupted sutures for both layers [ 13 ]. The obvious distinction between these training models and the model introduced here is that robotic surgery was used.…”

Section: Discussionmentioning

confidence: 99%

In vivoporcine training model for laparoscopic Roux-en-Y choledochojejunostomy

Lee

Hong

2015

Ann Surg Treat Res

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“…smaller incisions, decreased pain and earlier return to normal functioning. Robotic biliary surgery has proved feasible in an animal model (6)(7)(8) and major biliary surgery has been conducted safely in a paediatric population (9,10), although the enteroenteric anastomoses were performed extra-corporeally. Intracorporeal enteroenteric anastomosis is routinely performed in other fields of surgery (11)(12)(13).…”

Section: Discussionmentioning

confidence: 99%

Robotic choledochojejunostomy with intracorporeal Roux limb construction

Kohn

Overby

Martinie

2008

Robotics Computer Surgery

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“…In three earlier studies, we suggested alternative methods for reconstruction: using the gallbladder for a fl ap(4), utilizing a vascular prosthetic graft (5), or doing the operation as robotic-assisted by the da Vinci laparoscopic system (6). However, sometimes -maybe more often than is utilized at present -reconstruction can be done by duct-to-duct repair, which prompted us to do the present study, evaluating the natural healing of choledocho-choledochostomies.…”

Section: Discussionmentioning

confidence: 99%