Laparoscopic simulation for biliodigestive bypasses at a surgical training center in Quito, Ecuador
DOI:
https://doi.org/10.47464/MetroCiencia/vol34/1/2026/6-25Keywords:
Bilioenteric bypass, Laparoscopy, surgical anastomosis, surgical simulationAbstract
Introduction: Bilioenteric anastomoses are among the most technically demanding procedures in hepatobiliary surgery. When performed using minimally invasive approaches, they require advanced laparoscopic skills and precise suturing. Surgical simulation has emerged as an important strategy to shorten the learning curve and improve technical performance. Objective: To evaluate the feasibility, reproducibility, and educational value of a laparoscopic simulation model using ex vivo biological tissues for training in bilioenteric anastomoses, and to assess technical performance in a simulated environment. Methods: A descriptive experimental study was conducted involving 50 simulated laparoscopic bilioenteric anastomoses using ex vivo biological models. Variables analyzed included operative time, type of anastomosis, suture material and gauge, anastomotic diameter, and the presence of leakage assessed by hydropneumatic testing. Statistical analysis included an independent samples t-test comparing the first 10 and last 10 cases, linear regression to evaluate the learning curve, and cumulative sum (CUSUM) analysis to determine the inflection point of surgical competence. Results: The mean anastomosis time was 33.16 ± 11.9 minutes. End-to-side anastomoses predominated (98%), most commonly performed with 5-0 polypropylene sutures. A significant reduction in operative time was observed between the initial and final case blocks (p = 0.013). Linear regression demonstrated a progressive improvement consistent with a learning curve (y = 50.49 − 0.68x; p < 0.001). CUSUM analysis identified an inflection point at case 19. The leakage rate was 10% (n = 5), associated with identifiable and correctable technical errors. Conclusions: Low-cost laparoscopic simulation using ex vivo biological models represents a feasible, reproducible, and effective training strategy for bilioenteric anastomoses, particularly valuable in resource-limited settings.
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