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

We used a defrosted porcine aorta segment as a simile of the human main biliary duct. After inserting several chick peas into the aortic lumen to represent gallstones, both ends were ligated and affixed to a cork sheet, which was then placed inside a standard laparoscopic training box. For the insertion of the choledochoscope, it was necessary to make a 15 mm longitudinal incision with the laparoscopic scissors to simulate a choledochotomy. This allowed for proximal and distal exploration, and the chick peas were able to be extracted with a dormia basket. Both the laparoscopic and endoscopic visions achieved were very similar to an authentic surgical setting (Figs. 1 and 2). The model was also used to practice laparoscopic placement of T-tube drains and for the suture of the “bile duct”. The students worked in pairs: one handled the choledochoscope, and the other the laparoscope and the dormia basket.

Fig. 1.

Choledochoscopy inside a defrosted porcine aorta.

Fig. 2.

Choledochoscopy image: chick peas in the aorta lumen.

Discussion

Proper training in laparoscopic surgery requires practicing with experimental models before residents are able to perform laparoscopic surgical procedures in patients. Several simulation models of the main bile duct have been described with this objective.^1–4 Live animal models provide a more realistic setting, but they are expensive and involve ethical as well as legal implications. Canine inferior vena cava and saphenous veins have also been used.^3,4 Currently, there are virtual models, but these are expensive and the tactile sensation is not the same as in actual surgery. The laparoscopic model that we report for learning bile duct exploration is inexpensive and easily available, while providing tissue manipulation that is very similar to real life. This enables students to practice not only the insertion of the choledochoscope, but also the extraction of calculi and primary closure or T-tube drain placement.