Hydro-Jet Assisted Laparoscopic Partial Nephrectomy: Initial Experience in a Porcine Model

Shekarriz, H.; Shekarriz, Bijan; Upadhyay, Jyoti; Bürk, C.; Bruch, David P. Wood Hans-Peter

doi:10.1016/s0022-5347(05)67872-x

Cited by 48 publications

(27 citation statements)

References 22 publications

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Section: Discussionmentioning

confidence: 99%

“…The vessels were then coagulated under direct vision. 13 The hydrojet-assisted laparoscopic nephrectomy was also performed successfully in a calf model without hilar vessel control, thus completely avoiding warm ischemia.14 In 2000, Basting et al 15 used hydrojet in open renal sparing surgery without hilar control in 24 patients. They found the hydrojet could achieve precise hemostasis with little damage to the surrounding tissues.…”

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confidence: 99%

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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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Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

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

Gao

Chen

et al. 2014

International Surgery

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“…Blood vessels and the collecting system are not penetrated if a 400-600 psi pressure is used [57]. Shekarriz et al have investigated this technology during LPN with hilar control in the porcine model [58] and reported a virtually bloodless field with the vessels and collecting system preserved. Moinzadeh et al [57] similarly evaluated hydro-jet assisted LPN in the calf model.…”

Section: Water (Hydro) Jet Dissectionmentioning

confidence: 99%

Laparoscopic Partial Nephrectomy – Current State of the Art

P¹,

Dason²,

Kapoor³

2012

Emerging Research and Treatments in Renal Cell Carcinoma

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“…Various laparoscopic instruments have been used for the resection of renal masses or nonfunctional renal components [18,[21][22][23] (Table 1). The goal of LPN is to use a minimally invasive approach to remove small renal tumors without compromising cancer control or causing cancer spillage.…”

Section: Techniquementioning

confidence: 99%

Laparoscopic partial nephrectomy and minimally invasive nephronsparing surgery

et al. 2003

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Surgical extirpation remains the most effective therapy for renal cell carcinoma. The surgical management of renal masses has evolved away from radical nephrectomy and now includes nephron-sparing surgery for small tumors. Nephron-sparing surgery has similar cure rates and does not appear to compromise cancer control. As the detection of small renal masses by widespread abdominal imaging continues to increase, so will the demand for minimally invasive nephron-sparing procedures. Despite progress in surgical techniques, laparoscopic partial nephrectomy remains a technically challenging procedure. In this review, we discuss the challenges and recent advances in laparoscopic partial nephrectomy and other minimally invasive approaches to renal masses.

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Hydro-Jet Assisted Laparoscopic Partial Nephrectomy: Initial Experience in a Porcine Model

Cited by 48 publications

References 22 publications

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

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

Laparoscopic Partial Nephrectomy – Current State of the Art

Laparoscopic partial nephrectomy and minimally invasive nephronsparing surgery

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