SIMULAP and Laparoscopic Common Bile Duct Exploration Simulator.

Sergio Rojas-ortega, MD, Emina Pasic, MD, Rachid Cesin, MD, Gerardo Reed, MD. Hospital Angeles Puebla

INTRODUCTION: Many surgeons are not comfortable in treating common bile duct stones during laparoscopic cholecystectomy. However if the diagnosis is established during intraoperative cholangiography, the surgeon is confronted with a therapeutic dilemma that is, the choice between laparoscopic common bile duct exploration, conversion to open surgery, or postoperative sphincterotomy.

MATERIAL and METHODS: In order to show how easy can be to perform a laparoscopic common bile duct exploration (LCBDE), we showed a video to 20 general surgeons, and then invited them to the laboratory where we set the SIMULAP for common bile duct exploration with a flexible choledocoscope. Each surgeon performed LCBDE: transcystic and choledocotomy technique. We measured the time to complete the exploration, succes in common bile duct extraction, previous knowledge of the instrumentation and technique, and the impact in their general practice.

RESULTS: Only 10% of the group had experience with the flexible choledocoscope and the instrumentation needed to perform LCBDE. 0% had experience in clinical LCBDE. We instructed the technique in the simulator and measured the time for each participant. The time to perform LCBDE in the simulator was: 15 min /+- 5 min for the transcystic technique, and 25 min / +- 8 min for the choledocotomy technique. We asked each surgeon what will be the impact in their general practice after they completed the simulation, and was 50% in favor of LCBDE as the treatment for common bile duct stones.

CONCLUSION: Simulators can impact positively in the surgeons practice once they know how to perform a technique. Obviously this is the first step on our path to clinical practice, but as many techniques the daily practice in simulators can short the learning curve in LCBDE.

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