A suitable animal model for laparoscopic hepatic resection training.
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.
Teh
Swee H
SH
Department of Surgery, Oregon Health & Science University, Portland, OR, USA.
Hunter
John G
JG
Sheppard
Brett C
BC
D000818:Animals; D006498:Hepatectomy / Q000193:education* / Q000379:methods*; D010535:Laparoscopy; D008099:Liver / Q000033:anatomy & histology* / Q000601:surgery*; D023421:Models, Animal; D012756:Sheep
J Gastrointest Surg. 2004 Feb;8(2):213-6
15036198
Indian J Gastroenterol. 2005 May-Jun;24(3):95-6
16041098
Ann Surg. 2005 Aug;242(2):267-75
16041218
Ann Surg. 1996 Jun;223(6):673-85; discussion 685-7
8645041
Surgery. 2002 Dec;132(6):1064-8; discussion 1068-9
12490856
Dig Surg. 1998;15(2):135-9
9845575
J Laparoendosc Adv Surg Tech A. 2004 Oct;14(5):325-8
15630952
Br J Surg. 1998 Oct;85(10):1423-7
9782030
Surgery. 2004 Oct;136(4):804-11
15467665
Ann Surg. 2002 Jul;236(1):90-7
12131090
Surgery. 2005 Aug;138(2):165-70
16153423
Surg Endosc. 2003 Jan;17(1):23-30
12364994
Surg Endosc. 1998 Mar;12(3):232-5
9502702
Surg Endosc. 2002 Aug;16(8):1175-81
12189479
Surg Endosc. 1993 Nov-Dec;7(6):505-10
8272996
Surgeon. 2005 Jun;3(3):125-30, 132-3, 135-8
16075996
Clin Transplant. 2003;17 Suppl 9:39-43
12795667
Indian J Gastroenterol. 2005 May-Jun;24(3):111-3
16041103
Dis Colon Rectum. 2004 Aug;47(8):1310-6
15484344
Br J Surg. 2006 Jan;93(1):67-72
16273531
Surg Endosc. 2003 May;17 (5):750-3
12616391
Ann Surg. 2000 Dec;232(6):753-62
11088070
J Gastrointest Surg. 2000 Mar-Apr;4(2):178-84
10675241
Ann Surg. 1997 Oct;226(4):483-9; discussion 489-90
9351716
N Engl J Med. 1994 Feb 10;330(6):409-19
8284008
Chirurg. 1993 Mar;64(3):195-7
8482128
Arch Surg. 2000 Jul;135(7):854-9
10896382
Surg Today. 2002;32(8):711-5
12181722
HPB Surg. 1990 Jul;2(3):189-202; discussion 202-4
2278916