title: A new experimental model of calculous cholecystitis suitable for the evaluation and training of minimally invasive approaches to cholecystectomy.
abstract: 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. The values of WBC, CRP and IL-6 increased significantly (vs. baseline) on POD 1, 2 and 3 (p < 0.05) and then normalised. 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.
authors: Institute of Animal Physiology and Genetics Academy of Sciences of the Czech Republic (AS CR), Libechov, Czech Republic. ondrejryska@centrum.cz.
authors: Ondrej
authors: O
authors: Ryska
authors: Department of Surgery, Horovice Hospital, Horovice, Czech Republic.
authors: Zuzana
authors: Z
authors: Serclova
authors: Department of Hepatogastroenterology, Institute for Clinical and Experimental Medicine, Prague, Czech Republic.
authors: Jan
authors: J
authors: Martinek
authors: Surgery Department, Second Faculty of Medicine, Charles University and the Military University Hospital Prague, Prague, Czech Republic.
authors: Radek
authors: R
authors: Dolezel
authors: Surgery Department, Second Faculty of Medicine, Charles University and the Military University Hospital Prague, Prague, Czech Republic.
authors: Jaroslav
authors: J
authors: Kalvach
authors: Institute of Animal Physiology and Genetics Academy of Sciences of the Czech Republic (AS CR), Libechov, Czech Republic.
authors: Stefan
authors: S
authors: Juhas
authors: Institute of Animal Physiology and Genetics Academy of Sciences of the Czech Republic (AS CR), Libechov, Czech Republic.
authors: Jana
authors: J
authors: Juhasova
authors: Department of Gastroenterology, First Faculty of Medicine, Charles University and the Military University Hospital, Prague, Czech Republic.
authors: Bohus
authors: B
authors: Bunganic
authors: Department of Anaesthesiology, First Faculty of Medicine, The Military University Hospital Prague, Prague, Czech Republic.
authors: Eva
authors: E
authors: Laszikova
authors: Surgery Department, Second Faculty of Medicine, Charles University and the Military University Hospital Prague, Prague, Czech Republic.
authors: Miroslav
authors: M
authors: Ryska
mesh_terms: D000818:Animals; D017081:Cholecystectomy, Laparoscopic / Q000193:education* / Q000379:methods; D041761:Cholecystolithiasis / Q000601:surgery*; D004195:Disease Models, Animal; D019060:Minimally Invasive Surgical Procedures; D057605:Natural Orifice Endoscopic Surgery / Q000193:education* / Q000379:methods; D013552:Swine; D016896:Treatment Outcome
keywords: Animal model; Cholecystolithiasis; Laparoscopic cholecystectomy; Learning curve; NOTES