Experimental application of pulsed laser‐induced water jet for endoscopic submucosal dissection: Mechanical investigation and preliminary experiment in swine

Sato, Chiaki; Nakano, Toru; Nakagawa, Atsuhiro; Yamada, Masato; Yamamoto, Hiroaki; Kamei, Takashi; Miyata, Go; Sato, Akira; Fujishima, Fumiyoshi; Nakai, Masaaki; Niinomi, Mitsuo; Takayama, K.; Tominaga, Teiji; Satoh, Susumu

doi:10.1111/j.1443-1661.2012.01375.x

Cited by 18 publications

(21 citation statements)

References 37 publications

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“…Although the water jet dissection clears off the fine, trabecular hepatic infrastructure, which is found a few centimeters beneath the surface of Glisson's capsule, more efficiently than other techniques, these findings of limited blood loss and fewer transfusions can be better explained by the precise identification and clearance of the portal and hepatic venous structures deep within the parenchyma of the liver achieved by the water jet device [24]. Despite these advantages, the size of the pressure-driven continuous water jet device and the amount of water required have prevented its incorporation into minimally invasive instruments [27]. …”

Section: Discussionmentioning

confidence: 99%

The Dissection Profile and Mechanism of Tissue-Selective Dissection of the Piezo Actuator-Driven Pulsed Water Jet as a Surgical Instrument: Laboratory Investigation Using Swine Liver

et al. 2014

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Background/Purpose: The water jet technique dissects tissue while sparing cord-like structures such as blood vessels. The mechanism of such tissue-selective dissection has been unknown. The novel piezo actuator-driven pulsed water jet (ADPJ) system can achieve dissection with remarkably reduced water consumption compared to the conventional water jet; however, the system's characteristics and dissection capabilities on any organ have not been clarified. The purposes of this study were to characterize the physical properties of the novel ADPJ system, evaluate the dissection ability in swine organs, and reveal the mechanism of tissue-selective dissection. Methods: The pulsed water jet system comprised a pump chamber driven by a piezo actuator, a stainless steel tube, and a nozzle. The peak pressure of the pulsed water jet was measured through a sensing hole using a pressure sensor. The pulsed water jet technique was applied on swine liver in order to dissect tissue on a moving table using one-way linear ejection at a constant speed. The dissection depth was measured with light microscopy and evaluated histologically. The physical properties of swine liver were evaluated by breaking strength tests using tabletop universal testing instruments. The liver parenchyma was also cut with three currently available surgical devices to compare the histological findings. Results: The peak pressure of the pulsed water jet positively correlated with the input voltage (R² = 0.9982, p < 0.0001), and this was reflected in the dissection depth. The dissection depth negatively correlated with the breaking strength of the liver parenchyma (R² = 0.6694, p < 0.0001). The average breaking strengths of the liver parenchyma, hepatic veins, and Glisson's sheaths were 1.41 ± 0.45, 8.66 ± 1.70, and 29.6 ± 11.0 MPa, respectively. The breaking strength of the liver parenchyma was significantly lower than that of the hepatic veins and Glisson's sheaths. Histological staining confirmed that the liver parenchyma was selectively dissected, preserving the hepatic veins and Glisson's sheaths in contrast to what is commonly observed with electrocautery or ultrasonic instruments. Conclusions: The dissection depth of liver tissue is well controlled by input voltage and is influenced by the moving velocity and the physical properties of the organ. We showed that the device can be used to assure liver resection with tissue selectivity due to tissue-specific physical properties. Although this study uses an excised organ, further in vivo studies are necessary. The present work demonstrates that this device may function as an alternative tool for surgery due to its good controllability of the dissection depth and ability of tissue selectivity.

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Section: Discussionmentioning

confidence: 99%

The Dissection Profile and Mechanism of Tissue-Selective Dissection of the Piezo Actuator-Driven Pulsed Water Jet as a Surgical Instrument: Laboratory Investigation Using Swine Liver

et al. 2014

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“…The study was approved by the Ethics Committee of Tohoku University Hospital, and informed consent was obtained from all participants. The breaking strengths of each site in the kidney were measured using a compact table-top universal tester (model EZ-S with force transducer SM-20N-168; Shimadzu Co., Ltd., Kyoto, Japan) according to the previous reports (Seki and Iwamoto 1998;Sato et al 2013). …”

Section: Measurement Of the Breaking Strength In Human Kidneymentioning

confidence: 99%

The Piezo Actuator-Driven Pulsed Water Jet System for Minimizing Renal Damage after Off-Clamp Laparoscopic Partial Nephrectomy

Kamiyama

Yamashita

Nakagawa

et al. 2017

Tohoku J. Exp. Med.

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In the setting of partial nephrectomy (PN) for renal cell carcinoma, postoperative renal dysfunction might be caused by surgical procedure. The aim of this study was to clarify the technical safety and renal damage after off-clamp laparoscopic PN (LPN) with a piezo actuator-driven pulsed water jet (ADPJ) system. Eight swine underwent off-clamp LPN with this surgical device, while off-clamp open PN was also performed with radio knife or soft coagulation. The length of the removed kidney was 40 mm, and the renal parenchyma was dissected until the renal calyx became clearly visible. The degree of renal degeneration from the resection surface was compared by Hematoxylin-Eosin staining and immunostaining for 1-methyladenosine, a sensitive marker for the ischemic tissue damage. The mRNA levels of neutrophil gelatinase-associated lipocalin (Ngal), a biomarker for acute kidney injury, were measured by quantitative real-time PCR. Off-clamp LPN with ADPJ system was successfully performed while preserving fine blood vessels and the renal calix with little bleeding. In contrast to other devices, the resection surface obtained with the ADPJ system showed only marginal degree of ischemic changes. Indeed, the expression level of Ngal mRNA was lower in the resection surface obtained with the ADPJ system than that with soft coagulation (p = 0.02). Furthermore, using the excised specimens of renal cell carcinoma, we measured the breaking strength at each site of the human kidney, suggesting the applicability of this ADPJ to clinical trials. In conclusion, off-clamp LPN with the ADPJ system could be safely performed with attenuated renal damage.

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“…Partial nephrectomy is then completed expeditiously under warm ischemia with limited time Waterjet dissection has been used for selective dissection of the parenchyma of liver, 4-6 pancreatic necrosectomy, 7 and endoscopic submucosal dissection for gastrointestinal tumors. [8][9][10] In this study, we investigated whether waterjet resection is applicable or feasible for partial nephrectomy without temporary ischemia in a porcine model. …”

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“…[8][9][10] In this study, we investigated whether waterjet resection is applicable or feasible for partial nephrectomy without temporary ischemia in a porcine model.…”

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Waterjet Dissection for Partial Nephrectomy Without Hilar Clamping in a Porcine Model

Gao

Chen

et al. 2014

International Surgery

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Hilar clamping is typically used in partial nephrectomy to control hemorrhage, which may damage the renal tissue under warm ischemia conditions. The purpose of this study was to evaluate waterjet technology in partial nephrectomy without renal hilar vascular control in a porcine model. Bilateral partial nephrectomy using waterjet was performed in 8 pigs (16 kidneys: 8 for wedge resections, 8 for pole resections). The operations were performed successfully in all animals. The mean dissection time was 30.6 6 2.9 minutes for pole resections and 36.5 6 3.5 minutes for wedge resections. The mean blood loss was 51.6 6 11.7 mL for pole resections and 38.7 6 9.2 mL for wedge resections. The novel waterjet technique provided precise and effective hydrodissection of the kidney, avoiding damage to the vascular structures or collecting system.Key words: Partial nephrectomy -Waterjet dissection -Animal experiment K idney cancer is one of the most common cancers in the urinary system. More and more asymptomatic small renal tumors are diagnosed because of the wide use of imaging technologies. 1For decades, radical nephrectomy was considered the gold standard treatment for localized renal cancer. In recent years, nephron-sparing procedures (partial nephrectomy) have been demonstrated to have similar outcomes to traditional radical nephrectomy for small renal tumors.2 However, partial nephrectomy is a challenging operation with a high risk of parenchymal bleeding and damage to the collecting system. Renal hilar vessel clamping is still the first choice to minimize the parenchymal bleeding. Partial nephrectomy is then completed expeditiously under warm ischemia with limited time Waterjet dissection has been used for selective dissection of the parenchyma of liver, 4-6 pancreatic necrosectomy, 7 and endoscopic submucosal dissection for gastrointestinal tumors. [8][9][10] In this study, we investigated whether waterjet resection is applicable or feasible for partial nephrectomy without temporary ischemia in a porcine model. Materials and MethodsThe waterjet dissector Waterjet surgery, a new form of dissection that has been successfully used for several years, separates the different tissue types with their varying elasticity and firmness with the help of precisely adjusted water pressure.5-7 The kinetic energy of the waterjet carefully separates the layers of tissue.5-7 The ERBEJET 2 (ERBE Elektromedizin GmbH, Tübingen, Germany) is a waterjet surgical device for the preparation and separation of tissue, suitable for preserving layering. The selective separation property of water supports the surgeon in the dissection of parenchymal tissue (e.g., liver, spleen, kidney, brain) while sparing blood vessels and nerves. By using ERBEJET2, blood vessels and nerves are preserved by using predefined water pressures, while the surrounding tissue is selectively dissected. Furthermore, the ERBEJET2 is compatible with the advanced electrosurgical controller ERBE VIO (ERBE Elektromedizin). Animal experimentsEight pigs, weighing approximately 40 ...

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Experimental application of pulsed laser‐induced water jet for endoscopic submucosal dissection: Mechanical investigation and preliminary experiment in swine

Abstract: The results showed that the present endoscopic pulsed jet system is a useful alternative for a safe ESD with minimum tissue injury.

Cited by 18 publications

References 37 publications

The Dissection Profile and Mechanism of Tissue-Selective Dissection of the Piezo Actuator-Driven Pulsed Water Jet as a Surgical Instrument: Laboratory Investigation Using Swine Liver

The Dissection Profile and Mechanism of Tissue-Selective Dissection of the Piezo Actuator-Driven Pulsed Water Jet as a Surgical Instrument: Laboratory Investigation Using Swine Liver

The Piezo Actuator-Driven Pulsed Water Jet System for Minimizing Renal Damage after Off-Clamp Laparoscopic Partial Nephrectomy

Waterjet Dissection for Partial Nephrectomy Without Hilar Clamping in a Porcine Model

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