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Laparoscopic left hepatectomy in a goat as a training model for laparoscopic anatomic liver resection: results of training courses with a total of 70 goats

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Abstract

Background

To create a suitable animal model for the training of laparoscopic anatomic liver resection, we performed left hepatectomy using a goat and found its suitability. We have since started using goats for wet-lab training and have gradually standardized the relevant procedures. Herein, we report our standardized training procedures using a goat and discuss its feasibility as a novel training model.

Methods

The standardized wet-lab training courses of laparoscopic liver resection conducted on 62 tables with a total of 70 goats were reviewed. The training course began by encircling the hepatoduodenal ligament for the Pringle maneuver, which was repeated during the parenchymal dissection. Following partial liver resection of the left lateral section, left hepatectomy was performed by a standardized procedure for humans in which the liver was split, exposing the entire length of the middle hepatic vein trunk from the dorsal side after extrahepatic transection of the left Glissonean pedicle. If a goat deceased before initiating left hepatectomy, the training was restarted with a new goat. The surgical procedures were performed by surgeons of varying skill levels.

Results

A total of 184 surgeons including 10 surgical residents participated in the training. Partial liver resection was initiated in 62 tables, with 8 (13%) dying during or after the procedure of partial liver resection. Subsequently, left hepatectomy was initiated in 61 and completed in 59 tables (98%), regardless of whether the goat survived or deceased, and was not completed in 2 tables (3%) due to time limitation. In 14 tables (23%), the goats deceased during the procedure, however, the procedure was completed. The causes of death were multifactorial, including massive bleeding, reperfusion injury after the Pringle maneuver, and carbon dioxide gas embolism.

Conclusions

Left hepatectomy in a goat is useful as a training model for laparoscopic anatomic liver resection.

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Authors and Affiliations

  1. Department of Surgery, Institute of Gastroenterology, Tokyo Women’s Medical University, 8-1, Kawada-Cho, Shinjuku-Ku, Tokyo, 162-8666, Japan

    Yusuke Kawamoto, Goro Honda, Yusuke Ome, Yutaro Matsunaga, Shuichiro Uemura, Naoki Yoshida, Yoshihito Kotera & Shunichi Ariizumi

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  1. Yusuke Kawamoto
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  2. Goro Honda
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  3. Yusuke Ome
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  4. Yutaro Matsunaga
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  5. Shuichiro Uemura
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  6. Naoki Yoshida
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  7. Yoshihito Kotera
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  8. Shunichi Ariizumi
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Corresponding author

Correspondence to Goro Honda.

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Disclosures

Goro Honda reports receiving lecture fees from Johnson and Johnson, Medtronic, and Integra Japan. Yusuke Kawamoto and Yusuke Ome report receiving lecture fees from Integra Japan. Yutaro Matsunaga, Shuichiro Uemura, Naoki Yoshida, Yoshihito Kotera, and Shunichi Ariizumi have no conflicts of interest or financial ties.

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Supplementary Information

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Supplementary file1 (MP4 62048 KB)—Supplemental Digital Content 1 Encircling of the hepatoduodenal ligament

Supplementary file2 (MP4 203917 KB)—Supplemental Digital Content 2 Laparoscopic left hepatectomy in a goat

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Kawamoto, Y., Honda, G., Ome, Y. et al. Laparoscopic left hepatectomy in a goat as a training model for laparoscopic anatomic liver resection: results of training courses with a total of 70 goats. Surg Endosc 37, 3634–3641 (2023). https://doi.org/10.1007/s00464-023-09864-4

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