Hepatic resection using a water jet dissector

Abstract

A newly-designed water jet dissector was used for hepatic resections in humans. To evaluate its usefulness, the water jet dissector was compared to an ultrasonic surgical aspirator in terms of average blood loss and time of operation. In hepatectomies on patients associated with liver cirrhosis, the average blood loss during hepatic resection using the water jet dissector was significantly smaller (P < 0.05) than that with the ultrasonic surgical aspirator. However, in hepatectomies on patients without cirrhosis, the average blood loss during hepatic resection did not significantly differ between the two groups. Neither did the time of operation significantly differ between the two procedures in hepatectomies on patients with and without liver cirrhosis. No serious complications attributable to the use of the water jet dissector were encountered. The water jet dissector is thus considered to be a useful new device for use in the transection of the liver during hepatic resections.

Holmium: YAG laser‐induced liquid jet knife: Possible novel method for dissection

“…Our results indicated possibility of the laser-induced liquid jet to meet those requirements. There are several other devices already available to meet those requirements such as the Cavitron ultrasonic surgical aspirator (CUSA) and instruments utilizing high-pressurized water jets [11][12][13][14]. The dissecting mechanism of laser-induced liquid jet is different from that of the CUSA, which emulsifies tissue by fine vibration of the tip without affecting tissue containing abundant collagen.…”

“…The harder structures remain unaltered, become visible, and may be easily separated [11]. Beneficial aspects of water jet usage in liver surgery include significant reduction of blood loss when compared to conventional devices by preservation of small blood vessels during dissection [11,12]. However, the three main problems of water jet usage are: (1) the existence of the ''hail storm'' effect caused by the back splash and vaporization from contact with persistently high-pressurized liquid, (2) the inability of the operator to gauge the distance between the tip of the handpiece and the organ due to air bubbles generated at the dissecting point, and (3) the risk of tumor dissemination caused by the splash of the high-pressurized water jet used in the tumor debulking [13,14].…”

Review: Research Toward Safer Resectionof the Cirrhotic Liver

“…In a pilot study involving 15 patients with cirrhosis who had hepatic inflow occlusion (Pringle maneuver) for 9-32 minutes during hepatic resection, a significant decrease in blood loss was achieved compared to a similar group of 15 patients operated on without the use of blood flow occlusion. In addition, no hemodynamic complications resulted and no changes were seen in liver function studies, followed for up to 3 weeks post op in the blood flow occluded group [36] [38,39].…”

The Aim of Technology During Liver Resection — A Strategy to Minimize Blood Loss During Liver Surgery

“…WJS can't coagulate or realize haemostasis and some study demonstrate that it cannot achieve a reduction of intra-operative blood loss and operating time if compared with traditional techniques [81], [82]; using this technique is possible cancerous seeding of the healthy abdominal organs and infection of the operators by hepatic viruses. Moreover in literature some cases of gas embolism are described using this device [83].…”