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

Yamada, Masato; Nakano, Toru; Sato, Chiaki; Nakagawa, Atsuhiro; Fujishima, Fumiyoshi; Kawagishi, Naoki; Nakanishi, Chikashi; Sakurai, Tadashi; Miyata, Goh; Tominaga, Teiji; Ohuchi, Noriaki

doi:10.1159/000365288

Cited by 23 publications

(28 citation statements)

References 34 publications

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“…Clinical case reports showed that a water jet with a pressure of 1000 to 1500 psi can selectively strip the stomach mucosa of the pig while causing minor damage to deeper tissue . In addition, another article reported that various components of the liver have various tolerance levels to water pressures, that is, for the liver parenchyma it was 87 to 341 psi, for the hepatic vein it was 876 to 1769 psi, and for the Glisson sheath it was 2364 to 8717 psi . How is it working on skin tissues?…”

Section: Discussionmentioning

confidence: 99%

“…• the present investigation is for the first time to demonstrate the selectivity of hydrosurgery system in debridement of burn wound • 50 burn wounds were created, hydrosurgery system was used to debride both burn wound and normal skin, histological analysis was performed thereafter • resection rate was significantly higher in the burn wound compared with the normal skin when the applied water pressure of hydrosurgery system range from 3000 to 5000 psi undergoing hydrosurgery. 15 Moreover, Kaehler et al reported that using the hydrosurgery system, the pig's gastric mucosa was stripped without damaging the stomach smooth muscle layer. 16 However, no report shows whether the hydrosurgery has a capability of tissue selectivity in the burn wound debridement.…”

Section: Key Messagesmentioning

confidence: 99%

“…Clinical practice has demonstrated that hydrosurgery‐based debridement produces a smoother wound base, causes less blood loss, does not penetrate into deeper tissue layers, shortens hospitalisation time, and has less frequent functional sequelae . Yamada et al reported that the different components of the pig's liver (parenchyma, hepatic veins, and Glisson's capsule) have statistically different resistances to rupture forces while undergoing hydrosurgery . Moreover, Kaehler et al reported that using the hydrosurgery system, the pig's gastric mucosa was stripped without damaging the stomach smooth muscle layer .…”

Section: Introductionmentioning

confidence: 99%

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Selective debridement of burn wounds using hydrosurgery system

Yuan

Yin

Zhang

et al. 2019

International Wound Journal

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In recent years, hydrosurgery is a technology that has been applied more and more in debridement procedures. However, the selectivity of hydrosurgery to cutaneous necrotic tissues has not been proved. This study was designed to investigate the possible tissue selectivity of hydrosurgery in the debridement in burn wounds. Deep partial‐thickness burns were produced on the back of porcine, and 48 hours later, both burn wounds and normal skin were debrided using the hydrosurgery system. Then tissue samples were taken, and histological staining was performed and observed under microscope. Burn wound resection rates and the normal skin damaged rates were measured. Our result indicated that the burn wounds were significantly more sensitive than the normal skin when the water pressure produced by the hydrosurgery system was set between 3000 and 5000 psi (pounds per square inch), that is, the necrotic tissue portions were debrided more easily than the normal skin tissue. Based on these data, we suggest that 3000 to 5000 psi of water pressure in the hydrosurgery system has a skin tissue selectivity in burn wounds.

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Section: Discussionmentioning

confidence: 99%

Section: Key Messagesmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Selective debridement of burn wounds using hydrosurgery system

Yuan

Yin

Zhang

et al. 2019

International Wound Journal

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“…CUSA is a surgical device dissecting tissues using tissue selectivity of supersonic vibration, but morphological structure after dissecting the tissues might be different between the ADPJ system and CUSA. Yamada et al (2014) reported that hepatectomy using the ADPJ system resulted in histologically less injury than the existing radio knife, the ultrasonic surgical system and the ultrasonic cutting shears in swine. The morphological structure after dissecting the liver parenchyma by the ultrasonic surgical system was destroyed, and the blood vessels and bile ducts were not preserved.…”

Section: Discussionmentioning

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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“…Nitta gelatin 1st Grade (G1211; Nitta Gelatin, Inc.), 3.5 wt% (gelatin weight/total weight) was dissolved in warm water and cooled to solidify at 280 K. Gelatin blocks with this composition have equivalent mechanical profiles to the brain parenchyma, so they can be used as a model of brain tissue. 17,21 The gelatin specimen was immersed into physiological saline, and the nozzle of the ADPJ was placed perpendicularly to the gelatin surface. A pulsed or continuous-flow water jet was ejected at different flow rates, and the cutting depth was measured.…”

Section: Evaluation Of Dissection Profile In Brain Phantom Experimentsmentioning

confidence: 99%

Ventricle wall dissection and vascular preservation with the pulsed water jet device: novel tissue dissector for flexible neuroendoscopic surgery

Kawaguchi¹,

Nakagawa²,

Endo³

et al. 2016

JNS

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OBJECT Neuroendoscopic surgery allows minimally invasive surgery, but lacks effective methods to control bleeding. Water jet dissection with continuous flow has been used in liver and kidney surgery since the 1980s, and is effective for tissue manipulation with vascular preservation, but involves some potential risks, such as elevation of intracranial pressure during application in the ventricles. The authors previously reported the efficacy of the actuator-driven pulsed water jet device (ADPJ) to dissect soft tissue with vascular preservation in microscopic neurosurgery. This feasibility study investigated the use of the ADPJ to reduce the amount of water usage, leading to more safety with sustained efficacy. METHODS A small-diameter pulsed water jet device was developed for use with the flexible neuroendoscope. To identify the optimal conditions for the water jet, the flow rate, water pressure, and distance between the nozzle and target were analyzed in an in vitro study by using a gelatin brain phantom. A ventricle model was used to monitor the internal pressure and temperature. For ex vivo experiments the porcine brain was harvested and ventricle walls were exposed, and subsequently immersed into physiological saline. For in vivo experiments the cortex was microsurgically resected to make the small cortico-ventricle window, and then the endoscope was introduced to dissect ventricle walls. RESULTS In the in vitro experiments, water pressure was approximately 6.5 bar at 0.5 mm from the ADPJ nozzle and was maintained at 1 mm, but dropped rapidly toward 50% at 2 mm, and became 10% at 3.5 mm. The ADPJ required less water to achieve the same dissection depth compared with the continuous-flow water jet. With the ventricle model, the internal pressure and temperature were well controlled at the baseline, with open water drainage. These results indicated that the ADPJ can be safely applied within the ventricles. The ADPJ was introduced into a flexible endoscope and the ventricle walls were dissected in both the ex vivo and in vivo conditions. The ventricle wall was dissected without obscuring the view, and the vascular structures were anatomically preserved under direct application. Histological examination revealed that both the vessels on the ventricle wall and the fine vessels in the parenchyma were preserved. CONCLUSIONS The ADPJ can safely and effectively dissect the ventricle wall, with vascular preservation in immersed conditions. To achieve the optimal result of tissue dissection with minimal surgical risk, the ADPJ is a potential device for neuroendoscopic surgery of the ventricles.

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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

Cited by 23 publications

References 34 publications

Selective debridement of burn wounds using hydrosurgery system

Selective debridement of burn wounds using hydrosurgery system

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

Ventricle wall dissection and vascular preservation with the pulsed water jet device: novel tissue dissector for flexible neuroendoscopic surgery

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