Les auteurs tiennent à remercier le Dr Ana Cotrim de consultation technique et le Dr Monzur Murshed pour l&#39;équipement. Ce travail a été en partie financée par les Instituts de recherche en santé.

1. Description du procédurale <ol><li> Voie sous-cutanée injecter 1 poids corporel ul / g de 0,5 mg / ml monohydrate de sulfate d&#39;atropine (Cat # 11330, Fluka, USA) dans chaque souris pour empêcher les sécrétions salivaires de perturber le mouvement des perfusions. </li><li> Anesthésier chaque souris avec 1 poids corporel ul / g de 100 mg / ml de kétamine et 20 mg / ml de xylazine (Phoenix scientifique, AR, USA) solution injecté par voie intra-péritonéale (IP) </li><li> Placez la souris sur une plate-forme en plastique sur mesure en position ventrale: les incisives supérieures sont bloqués sur un fil métallique, et les incisives mandibulaires sont accrochés sur une corde élastique pour maintenir la bouche ouverte. </li><li> Utilisez une seringue à insuline avec une aiguille 29-gauge (Cat # 600145, Tyco Healthcare, MA, USA) placé à l&#39;intérieur d&#39;un tube de 0,58 mm de diamètre en polyéthylène (Cat # 427410, Becton Dickinson, MD, USA; Figure 2). Le tube de polyéthylène est insérée au-dessus de 5 mm de la pointe d&#39;un manomètre 29-néedle. L&#39;aiguille est utilisé comme un guide rigide pour déplacer le tube de polyéthylène dans le canal de Wharton. Le tube de polyéthylène est insérée 3-5 mm à l&#39;intérieur du conduit. Notez que seul le tube de polyéthylène entre dans le canal de la glande salivaire alors que l&#39;aiguille reste en dehors de la gaine. Injecter 50 ul de solution à 0,4% filtrée tache bleu trypan (Cat # 15250, Gibco, USA) dans la glande sous-maxillaire par le conduit de la Wharton, qui se trouve juste sous la langue. La perfusion est délivré de façon régulière avec une pression positive sur le piston de la seringue, le doigt reste sur le piston, même après la perfusion de tous ont été livrés à la glande, afin d&#39;empêcher un reflux de la perfusion intra-orale. La solution de bleu trypan est utilisé dans la vidéo en tant que colorant pour démontrer la technique. </li><li> près avoir l&#39;injection de la solution de bleu trypan, la souris a été euthanasiée avant la dissection. Les glandes salivaires est exposé chirurgicalement afin de déterminer dans quelle mesure les perfusions ont effectivement restés dans laglande. </li></ol> 2. Les résultats représentatifs: Après les injections ont été injectés, la souris a été disséquée chirurgicalement exposer la glande salivaire post-canule. Comme le montre l&#39;image-2, la coloration foncée de la gaine de la Wharton fournit la preuve que la solution de bleu trypan a été infusé avec succès. <img src="/files/ftp_upload/3074/3074fig1.jpg" alt="Figure 1" /> Figure 1. Canulation de la glande sous-maxillaire de la souris. <img src="/files/ftp_upload/3074/3074fig2.jpg" alt="Figure 2" /> Tube de polyéthylène figure 2. Est enveloppé autour de la pointe d&#39;une aiguille 29-gauge. L&#39;aiguille de la seringue est utilisée comme un guide rigide pour déplacer le tube de polyéthylène dans le canal de Wharton. Le tube de polyéthylène est insérée (perforé) 3-5 mm à l&#39;intérieur du conduit. Notez que seul le tube de polyéthylène entre dans le canal de la glande salivaire alors que l&#39;aiguille reste en dehors de la gaine.

<ol>
	<li>Fox, P. C. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Acquired+salivary+dysfunction.+Drugs+and+radiation.">Acquired salivary dysfunction. Drugs and radiation.</a> Ann N Y Acad Sci. 842, 132-137 (1998).</li><li>Bhide, S. A., Miah, A. B., Harrington, K. J., Newbold, K. L., Nutting, C. M. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Radiation-induced+xerostomia:+pathophysiology,+prevention+and+treatment.">Radiation-induced xerostomia: pathophysiology, prevention and treatment.</a> Clin Oncol (R Coll Radiol). 21, 737-744 (2009).</li><li>Redman, R. S., Ball, W. D., Mezey, E., Key, S. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Dispersed+donor+salivary+gland+cells+are+widely+distributed+in+the+recipient+gland+when+infused+up+the+ductal+tree.">Dispersed donor salivary gland cells are widely distributed in the recipient gland when infused up the ductal tree.</a> Biotech Histochem. 84, 253-260 (2009).</li></ol>

Toutes les expériences ont été approuvés par le Comité de protection des animaux et de l&#39;Université étaient en conformité avec les lignes directrices du Conseil canadien de protection des animaux.

Une difficulté avec cette méthode canulation est d&#39;empêcher le reflux de la solution injectée. Même si la solution de bleu trypan a temporairement migré dans la glande salivaire succès, la sécrétion de salive pourrait interférer avec les perfusions et provoquer le reflux de la solution de bleu trypan hors de la glande. Par mesure de précaution, en plus d&#39;utiliser l&#39;atropine pour inhiber la sécrétion de la salive, la canule polyéthylène doit rester dans le conduit de Wharton et le piston de la ...

<table border="1"><tbody><tr><td> Nom du réactif </td><td> Type </td><td> Entreprise </td><td> Numéro de catalogue </td><td> Commentaires (optionnel) </td></tr><tr><td> L&#39;atropine </td><td> Drogue </td><td> Fluka </td><td> 11330 </td><td> Pour inhiber la sécrétion de la salive </td></tr><tr><td> La kétamine </td><td> Drogue </td><td> Phoenix scientifique </td><td></td><td> Sédation </td></tr><tr><td> Xylazine </td><td> Drogue </td><td> Phoenix scientifique </td><td></td><td></td></tr><tr><td> Tuyaux en polyéthylène (0,58 mm de diamètre) </td><td> Tube </td><td> Intramedic PE-10, Becton Dickinson Diagnostic Systems </td><td> 427410 </td><td> Pour insérer sur la pointe de l&#39;aiguille pour éviter les blessures des tissus lors de l&#39;insertion dans le conduit de Wharton. </td></tr><tr><td> Ultra seringue d&#39;insuline Comfort (avecune aiguille 29G) </td><td> Seringue </td><td> Tyco Healthcare </td><td> 600145 </td><td></td></tr><tr><td> 4% de bleu trypan </td><td> Tache </td><td> Gibco </td><td> 15250 </td><td></td></tr></tbody></table>

cannulation of the mouse submandibular salivary gland via the wharton's duct

Sévère hypofonction des glandes salivaires est fréquemment retrouvée chez les patients atteints du syndrome de Gougerot-Sjögren et ceux qui recevoir une irradiation thérapeutique dans leur tête et du cou pour le traitement du cancer. Les deux groupes de patients éprouvent des symptômes tels que la xérostomie (bouche sèche), dysphagie (mastication et de la déglutition altérée), caries dentaires graves, altération du goût, des infections oro-pharyngées (candidose), inflammation des muqueuses, des douleurs et de l&#39;inconfort. Une approche novatrice de la médecine régénérative pour le traitement de la glande salivaire hypo-fonction est spéculé RS Redman, E Mezey et al, 2009:. Cellules souches peuvent être déposés directement par canulation dans la glande comme une méthode efficace pour relancer les fonctions de l&#39;altération organe. On peut supposer que les cellules souches ont migré étrangers se différencier en cellules glandulaires à fonctionner dans le cadre de la glande salivaire hôte. En outre, cette technique de canulation est une méthode de livraison rapide et efficace pour les essais cliniquesdemande de transfert de gène. Ici, nous illustrons les étapes à suivre pour effectuer la procédure de cathétérisme de la glande salivaire sous-maxillaire de la souris via le conduit de la Wharton (figure 1). C3H souris (Charles River, Montréal, QC, Canada) sont utilisés pour cette expérience, qui ont été gardés sous des conditions conventionnelles propres au centre de l&#39;Université McGill ressources animales. Toutes les expériences ont été approuvés par le Comité de protection des animaux et de l&#39;Université étaient en conformité avec les lignes directrices du Conseil canadien de protection des animaux. Pour cette expérience, un bleu trypan solution est perfusée dans la glande à travers l&#39;ouverture de la gaine de Wharton en utilisant une seringue à insuline avec une aiguille de calibre 29-enfermé à l&#39;intérieur d&#39;un tube de polyéthylène. Par la suite, la souris est disséqué pour montrer que les perfusions migré dans la glande succès.

Watch this Scientific Journal Video about Cannulation of the Mouse Submandibular Salivary Gland via the Wharton's Duct at JoVE.com

Cannulation of the Mouse Submandibular Salivary Gland via the Wharton&#039;s Duct

Un protocole pour la canulation de la glande salivaire sous-maxillaire de la souris via le conduit de la Wharton est décrite. Pour cette expérience, la solution de bleu trypan est utilisé comme un teinturier de démontrer comment cette technique délivre effectivement des perfusions dans la glande cible, et de suggérer la fiabilité de cette nouvelle approche comme un potentiel clinique des médicaments / thérapie cellulaire pour la régénération des glandes salivaires.

Canulation de la glande salivaire sous-maxillaire de la souris via le conduit de Wharton

Severe salivary gland hypofunction is frequently found in patients with Sj&ouml;gren's syndrome and those who receiving therapeutic 
irradiation in their ...

cannulation-mouse-submandibular-salivary-gland-via-wharton-s

Research

JoVE Journal

Medicine

Cannulation of the Mouse Submandibular Salivary Gland via the Wharton's Duct

25.7K vues.  McGill University. Un protocole pour la canulation de la glande salivaire sous-maxillaire de la souris via le conduit de la Wharton est décrite. Pour cette expérience, la solution de bleu trypan est utilisé comme un teinturier de démontrer comment cette technique délivre effectivement des perfusions dans la glande cible, et de suggérer la fiabilité de cette nouvelle approche comme un potentiel clinique des médicaments / thérapie cellulaire pour la régénération des glandes saliva...

Vidéo: Cannulation of the Mouse Submandibular Salivary Gland via the Wharton's Duct

Collecting Saliva and Measuring Salivary Cortisol and Alpha-amylase in Frail Community Residing Older Adults via Family Caregivers

Salivary measures have emerged in bio-behavioral research that are easy-to-collect, minimally invasive, and relatively inexpensive biologic markers of stress. This article we present the steps for collection and analysis of two salivary assays in research with frail, community residing older adults-salivary cortisol and salivary alpha amylase. The field of salivary bioscience is rapidly advancing and the purpose of this presentation is to provide an update on the developments for investigators interested in integrating these measures into research on aging. Strategies are presented for instructing family caregivers in collecting saliva in the home, and for conducting laboratory analyses of salivary analytes that have demonstrated feasibility, high compliance, and yield quality specimens. The protocol for sample collection includes: (1) consistent use of collection materials; (2) standardized methods that promote adherence and minimize subject burden; and (3) procedures for controlling certain confounding agents. We also provide strategies for laboratory analyses include: (1) saliva handling and processing; (2) salivary cortisol and salivary alpha amylase assay procedures; and (3) analytic considerations.

We demonstrate: (1) procedures for collection of salivary samples in cognitive impaired older adults by family caregivers in the home setting, (2) procedures for measuring stress activity via salivary cortisol and alpha amylase, and (3) representative profiles. Protocols that allow researchers to study stress-linked processes advance our understanding of biological sensitivity and susceptibility.

Collecte de salive et de mesure du cortisol salivaire et l&#39;alpha-amylase dans Frail communautaires résidant personnes âgées par les aidants familiaux

Salivary measures have emerged in bio-behavioral research  that are easy-to-collect, minimally invasive, and relatively inexpensive  biologic markers of ...

Recherche

Médecine

Surgical Injury to the Mouse Pancreas through Ligation of the Pancreatic Duct as a Model for Endocrine and Exocrine Reprogramming and Proliferation

Expansion of pancreatic beta cells in vivo or ex vivo, or generation of beta cells by differentiation from an embryonic or adult stem cell, can provide new expandable sources of beta cells to alleviate the donor scarcity in human islet transplantation as therapy for diabetes. Although recent advances have been made towards this aim, mechanisms that regulate beta cell expansion and differentiation from a stem/progenitor cell remain to be characterized. Here, we describe a protocol for an injury model in the adult mouse pancreas that can function as a tool to study mechanisms of tissue remodeling and beta cell proliferation and differentiation. Partial duct ligation (PDL) is an experimentally induced injury of the rodent pancreas involving surgical ligation of the main pancreatic duct resulting in an obstruction of drainage of exocrine products out of the tail region of the pancreas. The inflicted damage induces acinar atrophy, immune cell infiltration and severe tissue remodeling. We have previously reported the activation of Neurogenin (Ngn) 3 expressing endogenous progenitor-like cells and an increase in beta cell proliferation after PDL. Therefore, PDL provides a basis to study signals involved in beta cell dynamics and the properties of an endocrine progenitor in adult pancreas. Since, it still remains largely unclear, which factors and pathways contribute to beta cell neogenesis and proliferation in PDL, a standardized protocol for PDL will allow for comparison across laboratories.

This protocol describes an injury model involving the surgical ligation of the pancreatic duct in the adult mouse pancreas, resulting in severe injury that establishes an environment that allows beta cell neogenesis and proliferation. This model can be used as a tool to study mechanisms involved in beta cell formation.

Blessure chirurgicale au pancréas de souris par ligature du canal pancréatique tant que modèle de endocrines et exocrines Reprogrammation et prolifération

Expansion of pancreatic beta cells in vivo or ex vivo, or generation of beta cells by differentiation from an embryonic or adult stem cell, can provide ...

Retroductal Submandibular Gland Instillation and Localized Fractionated Irradiation in a Rat Model of Salivary Hypofunction

Normal tissues that lie within the portals of radiation are inadvertently damaged. Salivary glands are often injured during head and neck radiotherapy. Irreparable cell damage results in a chronic loss of salivary function that impairs basic oral activities, and increases the risk of oral infections and dental caries. Salivary hypofunction and its complications gravely impact a patient's comfort. Current symptomatic management of the condition is ineffective, and newer therapies to assuage the condition are needed. 
Salivary glands are exocrine glands, which expel their secretions into the mouth via excretory ducts. Cannulation of these ducts provides direct access to the glands. Retroductal delivery of a contrast agent to major salivary glands is a routine out-patient procedure for diagnostic imaging. Using a similar procedure, localized treatment of the glands is feasible. However, performing this technique in preclinical studies with small animals poses unique challenges. In this study we describe the technique of retroductal administration in rat submandibular glands, a procedure that was refined in Dr. Bruce Baum's laboratory (NIH)1, and lay out a procedure for local gland irradiation.

Salivary gland hypofunction, a major adverse effect of head and neck radiotherapy diminishes a patient's quality of life. The demonstration of efficacy of new therapies in animal models is a prerequisite before clinical transition. This protocol describes retroductal administration and local irradiation of rat submandibular glands.

Retroductal Submandibulaire Gland instillation et Localized Fractionnée Irradiation dans un modèle de rat de salivaire Hyposécrétion

Normal tissues that lie within the portals of radiation are inadvertently damaged. Salivary glands are often injured during head and neck radiotherapy. ...

Pancreatic Duct Infusion: An Effective and Selective Method of Drug and Viral Delivery

The pancreas is a bifunctional organ with both endocrine and exocrine components. A number of pathologies can afflict the pancreas, including diabetes, pancreatitis, and pancreatic cancer. All three of these diseases mark active areas of study, not only to develop immediate therapy, but also to better understand their pathophysiology. There are few tools to further these areas of study. Pancreatic duct infusion is an important technique that can allow for lineage tracing, gene introduction, and cell line-specific targeting. The technique requires the intricate dissection of the second portion of the duodenum and ampulla, followed by the occlusion of the bile duct and the cannulation of the pancreatic duct. Although the technique is technically challenging at first, the applications are myriad. Ambiguity in the specifics of the procedure between groups highlighted the need for a standard protocol. This work describes the expression of a green fluorescent protein (GFP) within the pancreas after the pancreatic duct infusion of a viral vector expressing GFP versus a sham surgery. The infusion and therefore expression is specific to the pancreas, without expression present in any other tissue type.

Pancreatic duct infusion is an important technique that can allow for lineage tracing, gene introduction, and cell line-specific targeting. A pancreatic duct infusion technique for drug and viral delivery to pancreatic cells is presented here.

Perfusion de canal pancréatique: une méthode efficace et sélective d’administration de médicaments et de virus

The pancreas is a bifunctional organ with both endocrine and exocrine components. A number of pathologies can afflict the pancreas, including diabetes, ...

Murine Salivary Functional Assessment via Pilocarpine Stimulation Following Fractionated Radiation

Hyposalivation is commonly observed in the autoimmune reaction of Sj&#246;gren's syndrome or following radiation injury to the major salivary glands. In these cases, questions remain regarding disease pathogenesis and effective interventions. An optimized technique that allows functional assessment of the salivary glands is invaluable for investigating exocrine gland biology, dysfunction, and therapeutics. Here, we present a step by step approach to performing pilocarpine stimulated saliva secretion, including tracheostomy and the dissection of the three major murine salivary glands. We also detail the appropriate murine head and neck anatomy accessed during these techniques. This approach is scalable, allowing for multiple mice to be processed simultaneously, thus improving the efficiency of the work flow. We aim to improve the reproducibility of these methods, each of which has further applications within the field. In addition to saliva collection, we discuss metrics for quantifying and normalizing functional capacity of these tissues. Representative data are included from submandibular glands with depressed salivary gland function 2 weeks following fractionated radiation (4 doses of 6.85 Gy).

We present a detailed approach to performing saliva collection, including murine tracheostomy and the isolation of three major salivary glands.

Murine salivaire évaluation fonctionnelle par l’intermédiaire de Pilocarpine Stimulation suit fractionnés rayonnement

Hyposalivation is commonly observed in the autoimmune reaction of Sj&#246;gren's syndrome or following radiation injury to the major salivary glands. In ...

Radiation Treatment of Organotypic Cultures from Submandibular and Parotid Salivary Glands Models Key In Vivo Characteristics

Hyposalivation and xerostomia create chronic oral complications that decrease the quality of life in head and neck cancer patients who are treated with radiotherapy. Experimental approaches to understanding mechanisms of salivary gland dysfunction and restoration have focused on in vivo models, which are handicapped by an inability to systematically screen therapeutic candidates and efficiencies in transfection capability to manipulate specific genes. The purpose of this salivary gland organotypic culture protocol is to evaluate maximal time of culture viability and characterize cellular changes following ex vivo radiation treatment. We utilized immunofluorescent staining and confocal microscopy to determine when specific cell populations and markers are present during a 30-day culture period. In addition, cellular markers previously reported in in vivo radiation models are evaluated in cultures that are irradiated ex vivo. Moving forward, this method is an attractive platform for rapid ex vivo assessment of murine and human salivary gland tissue responses to therapeutic agents that improve salivary function.

Using three-dimensional organotypic cultures to visualize morphology and functional markers of salivary glands may provide novel insights into the mechanisms of tissue damage following radiation. Described here is a protocol to section, culture, irradiate, stain, and image 50&#8211;90 &#956;m thick salivary gland sections prior to and following exposure to ionizing radiation.

Traitement par rayonnement des cultures organotypiques de modèles de glandes salivaires sous-mandibulaires et parotides clés caractéristiques in vivo

Hyposalivation and xerostomia create chronic oral complications that decrease the quality of life in head and neck cancer patients who are treated with ...

A Mouse Model for Chronic Pancreatitis via Bile Duct TNBS Infusion

Chronic pancreatitis (CP) is a complex disease involving pancreatic inflammation and fibrosis, glandular atrophy, abdominal pain and other symptoms. Several rodent models have been developed to study CP, of which the bile duct 2,4,6 -trinitrobenzene sulfonic acid (TNBS) infusion model replicates the features of neuropathic pain seen in CP. However, bile duct drug infusion in mice is technically challenging. This protocol demonstrates the procedure of bile duct TNBS infusion for generation of a CP mouse model. TNBS was infused into the pancreas through the ampulla of Vater in the duodenum. This protocol optimized drug volume, surgical techniques, and drug handling during the procedure. TNBS-treated mice showed features of CP as reflected by bodyweight and pancreas weight reductions, changes in pain-associated behaviors, and abnormal pancreatic morphology. With these improvements, mortality associated with TNBS injection was minimal. This procedure is not only critical in generating pancreatic disease models but is also useful in local pancreatic drug delivery.

Chronic pancreatitis (CP) is a disease characterized by inflammation and fibrosis of the pancreas, often associated with intractable abdominal pain. This article focuses on refining the technique to generate a mouse model of CP via bile duct infusion with 2,4,6 -trinitrobenzene sulfonic acid (TNBS).

Un modèle murin pour la pancréatite chronique par perfusion de TNBS dans les voies biliaires

Chronic pancreatitis (CP) is a complex disease involving pancreatic inflammation and fibrosis, glandular atrophy, abdominal pain and other symptoms. ...

Establishment of a Mouse Severe Acute Pancreatitis Model using Retrograde Injection of Sodium Taurocholate into the Biliopancreatic Duct

The prevalence of acute pancreatitis (AP), especially severe acute pancreatitis (SAP), is increasing in younger age groups annually. However, there is a lack of effective treatments in the current clinical practice. With the easy accessibility of transgenic and knockout strains and their small size, which allows minimal doses of drugs required for in vivo evaluation, a well-established experimental model in mice is preferred for AP research. Moreover, SAP induced through sodium taurocholate (TC) is currently one of the most widely used and best characterized models. This model has been investigated for novel therapies and possible molecular events during the process of AP. Here, we present the generation of an AP mouse model using sodium taurocholate and a simple homemade microsyringe. Moreover, we also provide the methodology for the subsequent histology and serological testing.

A mouse model of severe acute pancreatitis is described herein. The procedure presented here is very rapid, simple, and accessible, thereby potentially allowing the study of the molecular mechanisms and different therapeutic interventions in acute pancreatitis in a convenient way.

Établissement d’un modèle de pancréatite aiguë sévère chez la souris par injection rétrograde de taurocholate de sodium dans le canal biliopancréatique

The prevalence of acute pancreatitis (AP), especially severe acute pancreatitis (SAP), is increasing in younger age groups annually. However, there is a ...

Establishment of a Simple and Effective Rat Model for Intraoperative Parathyroid Gland Imaging

Parathyroid gland (PG) identification is a critical unmet need in thyroidectomy. The identification of the PG is challenging in thyroid surgery as it is similar in color to the thyroid gland. The lack of effective animal models in preclinical research is a severe limitation for the development of PG identification techniques. This protocol allows for the establishment of a simple and effective rat model for PG identification. In this model, black iron oxide nanoparticles (IONPs) are injected locally in the thyroid gland and rapidly diffuse within the thyroid gland but not the PG. A negatively stained PG and a positively stained thyroid gland can be easily identified by the naked eye without requiring external microscopes. The position of the PG can be identified by increasing the color contrast between the thyroid gland and the PG, based on the color of the black IONPs. This rat model is low-cost and convenient for PG identification, and the IONPs are a novel PG contrast agent.

To date, the development of parathyroid gland (PG) identification methods is limited by the lack of animal models in preclinical research. Here, we establish a simple and effective rat model for intraoperative PG imaging and evaluate its effectiveness by using iron oxide nanoparticles as a novel PG contrast agent.

Mise en place d’un modèle simple et efficace chez le rat pour l’imagerie peropératoire des glandes parathyroïdes

Parathyroid gland (PG) identification is a critical unmet need in thyroidectomy. The identification of the PG is challenging in thyroid surgery as it is ...

Laparoscopic Common Bile Duct Exploration in Patients with a Previous History of Biliary Tract Surgery

For recurrent choledocholithiasis, abdominal adhesions in previous surgeries lead to changes in anatomical structures, and a secondary injury occurs easily when performing another operation for laparoscopic common bile duct exploration (LCBDE), which was once considered a relative contraindication. In view of the limitations of the current surgical technique, this study summarized the surgical approaches and crucial anatomical landmarks for reoperation for LCBDE. Four general surgical approaches were proposed to expose the common bile duct, including the ligamentum teres hepatis approach, the anterior hepatic duodenal ligament approach, the right hepatic duodenal ligament approach, and the hybrid approach. Additionally, this study highlighted seven crucial anatomical landmarks: the parietal peritoneum, the gastrointestinal serosa, the ligamentum teres hepatis, the inferior margin of the liver, the gastric antrum, the duodenum, and the hepatic flexure of the colon, which were helpful to safely separate abdominal adhesions and expose the common bile duct. Moreover, to shorten the time of choledocholithotomy, a sequential method was innovatively applied for the removal of the stones in common bile duct. Mastering the above surgical approaches, including identifying crucial anatomical landmarks and adopting the sequential method will improve the safety of reoperation for LCBDE, shorten the operation time, promote the fast recovery of patients, reduce postoperative complications, and contribute to the popularization and application of this technique.

Programmed surgery based on surgical methods and anatomical markers helps shorten the operation time, reduce complications, and improve the safety of the surgery. This study investigated and summarized the surgical methods and anatomic markers of laparoscopic common bile duct exploration in patients with a history of biliary tract surgery.

Exploration laparoscopique des voies biliaires chez les patients ayant des antécédents de chirurgie des voies biliaires

For recurrent choledocholithiasis, abdominal adhesions in previous surgeries lead to changes in anatomical structures, and a secondary injury occurs ...