IPEG 2020 TOP ABSTRACT: LAPAROSCOPIC CHOLEDOCHAL CYST EXCISION WITH DUCTOPLASTY AND HEPATICODUODENOSTOMY USING A RIGHT LATERAL APPROACH
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What the experts said
A modified right-lateral trocar approach was used to suit the ergonomics of a left-handed surgeon for choledochal cyst excision.
The gallbladder and falciform ligament were suspended using a transcutaneous monofilament absorbable stitch.
An accessory biliary ductal structure was found emptying directly into the choledochal cyst, separate from the right and left hepatic ducts.
Needle aspiration was used to confirm the contents of the accessory ductal structure.
The distal portion of the choledochal cyst was ligated with an absorbable tie and divided with a 5 millimeter stapler.
The proximal end of the choledochal cyst was clipped and divided just distal to the confluence of the right and left hepatic ducts.
A ductoplasty was performed between the accessory duct and the common hepatic duct.
The ductoplasty suturing was done intracorporeally with the left hand being dominant.
A duodenostomy was performed approximately 2.5 centimeters away from the pylorus.
A hepaticoduodenostomy was performed using intracorporeal suturing and knot tying with the left hand as the dominant hand.
A running stitch was used for the back posterior wall and interrupted stitches were used for the anterior wall of the hepaticoduodenostomy.
The left-sided port allowed a forward throw with the left-handed suturing technique.
By modifying the port position, excellent ergonomics for the left-hand dominant surgeon were achieved.
The completed anastomosis was tension-free.
At least 10% of surgeons are left-handed.
Specific mentoring and access to appropriate instruments for left-handed trainees is lacking.
Laparoscopy and laparoscopic instruments do not eliminate problems associated with instrument handling for left-handed surgeons.
It is possible to modify complex laparoscopic procedures to suit the ergonomics of left-handed surgeons.