Comparative evaluation of three laparoscopic cholecystectomy techniques in rabbits’ model

Author(s)

Monica Carolina Nery Wittmaack

• Document type: Doctoral Thesis
• Press: Jaboticabal. 2022-02-03.
• Institution: Universidade Estadual Paulista (Unesp). Faculdade de Ciências Agrárias e Veterinárias. Jaboticabal
• Defense date: 2021-08-31
• Advisor: Paola Castro Moraes

Abstract

Laparoscopic cholecystectomy (LC) has become the gold standard management option for benign gallbladder (GB) disease and cholelithiasis. The aim of this randomized study was to evaluate the intraoperative complications and perioperative outcome of rabbits undergoing 3 different techniques of LC. In this study, we compared the effect of different LC techniques on changes in liver function tests (LFTs). And finally, we investigated and compared the degree of postoperative adhesions and histopathological changes of the liver bed after LC techniques. Methods:30 white male New Zealand rabbits were divided into 3 groups. Group A (n=10) Fundus-first dome-down technique by Hook dissecting instrument and Roeder Slipknot applied for Cystic Duct Ligation. The GB was dissected free from the liver bed starting at the fundus toward the GB neck using Hook electrocautery (Karl–Storz 36 cm length). The cystic duct and cystic artery were ligated using extracorporeally Roeder slipknot - extracorporeal slipknot (Roeder knot). Group B (n=10) Conventional technique by Maryland dissecting forceps for GB dissection and Electrothermal Bipolar Vessel Sealing (EVBS) for Cystic duct seal. Rabbits underwent conventional technique using Bipolar Maryland dissecting forceps (maryland–36 cm length) and the EVBS LigaSure™ Maryland Jaw 5mm-23cm (Medtronic, Dublin, Ireland) for Cystic duct seal. Group C conventional technique by Electrothermal Bipolar Vessel Sealing (EBVS) for GB dissection and EVBS for cystic duct seal. Rabbits who underwent conventional technique dissection of the gallbladder by the LigaSure™ Maryland Jaw 5mm-23cm (Medtronic, Dublin, Ireland) and LigaSure™ for cystic duct seal. The surgical procedure data were collected and analyzed (GB perforation rate, time to GB bed dissection and length of surgery, bleeding from tissues adjacent to gallbladder)Blood samples were obtained pre-operatively and on day 3, 7 and day 15 after surgery to compare liver enzyme alterations (aspartate transaminase [AST], alanine transaminase [ALT], alkaline phosphatase [ALP], bilirubin, direct bilirubin, total protein, albumin; gamma-glutamyl transferase (GGT), fibrinogen.The necropsy analysis was performed 15 days after surgery, and the degree of postoperative adhesions was classified from 0 to 4. Liver samples for histological examination were taken from all groups. The presence of vi siderophages was evaluated and a scale from 1 to 4 was used for the degree of fibrosis, necrosis and giant cells. Group A presented a longer GB dissection time than groups B and C. GB perforation and bleeding from tissues adjacent to GB were similar among tested groups. GGT and ALP levels increased (p≤0.05) on day 3 post-operatively in group A. By the 15th postoperative day, the enzymes returned to the preoperative values. The median of giant cells, Necrosis, Fibrosis and proportion of Siderophags were not influenced by the CL techniques. Transient elevation of hepatic transaminases occurred after LC in all groups. Group A had a higher adherence score than groups B and C and was associated with the least predictable technique. LC can be performed using different techniques, although the use of EBVS is highly recommended. (AU)

• FAPESP's process: 17/23402-8 - Laparoscopic cholecystectomy using vessel sealant device and modification of technique using hand tied loop in rabbits: experimental study
• Grantee: Monica Carolina Nery Wittmaack
• Support Opportunities: Scholarships in Brazil - Doctorate