How we acquire suturing skills for laparoscopic hepaticojejunostomy

Area of Science:

• Pediatric Surgery
• Surgical Simulation
• Minimally Invasive Surgery

Background:

• Laparoscopic choledochal cyst excision and hepaticojejunostomy is a complex procedure.
• Laparoscopic suturing, needle driving, and knot tying are particularly challenging in infants and children.

Purpose of the Study:

• To develop and evaluate a laparoscopic hepaticojejunostomy simulator for training surgeons.
• To assess the effectiveness of simulator training in improving surgical skills for pediatric choledochal cyst treatment.

Main Methods:

• A laparoscopic hepaticojejunostomy simulator was designed based on infant CT data and 3D scanned clinical data.
• Surgeons in training (SITs) practiced on the simulator before performing clinical cases.
• Thirteen laparoscopic choledochal cyst excision and hepaticojejunostomy cases were analyzed post-simulator implementation.

Main Results:

• Six SITs performed 13 laparoscopic choledochal cyst excision and hepaticojejunostomy procedures.
• No cases of anastomotic bile leakage were reported after simulator training.
• The simulator accurately reproduced infant anatomy and pneumoperitoneum.

Conclusions:

• Laparoscopic disease-specific simulator practice is effective for acquiring secure hepaticojejunostomy skills.
• Simulator training serves as valuable off-the-job training for pediatric surgical procedures.
• This approach enhances patient safety in the treatment of choledochal cysts in children.