A suitable animal model for laparoscopic hepatic resection training |
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Authors: | Swee H Teh John G Hunter Brett C Sheppard |
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Institution: | (1) Department of Surgery, Oregon Health & Science University, Portland, OR, USA |
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Abstract: | Background There is a growing interest in using laparoscopy for hepatic resection. However, structured training is lacking in part because
of the lack of an ideal animal training model. We sought to identify an animal model whose liver anatomy significantly resembled
that of the human liver and to assess the feasibility of learning laparoscopic hepatic inflow and outflow dissection and parenchyma
transection on this model.
Methods The inflow and outflow structures of the sheep liver were demonstrated via surgical dissection and contrast studies. Laparoscopic
left major hepatic resections were performed.
Results The portal hepatis of all 12 sheep (8 for anatomic study and 4 for laparoscopic hepatic resection) resembled that of human
livers. The portal vein (PV) was located posteriorly; the common hepatic artery (CHA) and the common bile duct (CBD) were
located anterior medially and anterior laterally with respect to the portal hepatis. The main PV bifurcated into a short right
and a long left PV. The extrahepatic right PV then bifurcated into right posterior and anterior sectoral PV. The CBD and CHA
bifurcated into left and right systems. The cystic duct originated from the right hepatic duct. The cystic artery originated
from the right HA in 11/12 animals. The left hepatic vein drained directly into the inferior vena cava (IVC). The middle and
the right hepatic veins formed a short common channel before entering the IVC. Multiple venous tributaries drained directly
into IVC. Familiarity with sheep liver anatomy allowed laparoscopic left hepatic lobe (left medial and lateral segments) resection
to be performed with accuracy and preservation of the middle hepatic vein.
Conclusions The surgical anatomy of sheep liver resembled that of human liver. Laparoscopic major hepatic resection can be performed with
accuracy using this information. Sheep is therefore an ideal animal model for advanced surgical training in laparoscopic hepatic
resection. |
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Keywords: | Laparoscopy Hepatic resection Animal model Training Hepatic tumor |
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