A new experimental model of calculous cholecystitis suitable for the evaluation and training of minimally invasive approaches to cholecystectomy

0473805 - ÚŽFG 2018 RIV US eng J - Článek v odborném periodiku
Ryska, Ondřej - Šerclová, Z. - Martínek, J. - Doležel, R. - Kalvach, J. - Juhás, Štefan - Juhásová, Jana - Bunganič, B. - Lasziková, E. - Ryska, M.
A new experimental model of calculous cholecystitis suitable for the evaluation and training of minimally invasive approaches to cholecystectomy.
Surgical Endoscopy and Other Interventional Techniques. Roč. 31, č. 2 (2017), s. 987-994. ISSN 0930-2794. E-ISSN 1432-2218
Grant CEP: GA MZd(CZ) NT13634; GA MŠMT ED2.1.00/03.0124
Institucionální podpora: RVO:67985904
Klíčová slova: animal model * cholecystolithiasis * learning curve
Obor OECD: Gastroenterology and hepatology
Impakt faktor: 3.117, rok: 2017

Novel, less invasive approaches such as single-incision laparoscopic cholecystectomy or natural orifice transluminal endoscopic surgery require preclinical evaluation and training. Therefore, there is a need for an experimental model closely mimicking the clinical situation. The aim of our study was to create an experimental model of calculous cholecystitis in a large laboratory animal and test its feasibility for the evaluation of different techniques of cholecystectomy.
In 11 laboratory pigs, gallstones were placed inside the gallbladder laparoscopically. Levels of inflammatory markers-leucocytes (WBC), C-reactive protein (CRP) and interleukin 6 (IL-6)-were monitored on the postoperative days (POD) 1, 2, 3, 7 and 30. Abdominal ultrasound was performed 2 and 4 weeks after the operation. Four weeks after the lithiasis induction, laparoscopic cholecystectomy was performed. The control group consisted of ten healthy animals in which a cholecystectomy was performed. The pigs were monitored for 30 days after surgery. All removed gallbladders were assessed histologically.
The induction of lithiasis took 42 (35-52) min with no morbidity and mortality. Ultrasonography confirmed the presence of chronic calculous cholecystitis in all cases after 4 weeks. Laparoscopic cholecystectomy was significantly longer in animals with lithiasis, 63 (42-91) versus 46 (31-62) min (p = 0.018). Perioperative gallbladder wall perforation was significantly more frequent in the model group (8/11 vs. 1/10, p = 0.04). In contrast to healthy animals, all gallbladders with stones showed histological signs of chronic inflammation.
A new animal model of calculous cholecystitis was created. Laparoscopic cholecystectomy was more technically difficult compared to operating on a healthy gallbladder. This model may be a suitable tool for effective preclinical training and also for the evaluation of different techniques of cholecystectomy.
Trvalý link: http://hdl.handle.net/11104/0270941