Open Hepatic Transection Using Water-Jet Dissector
The first planned hemihepatectomy was performed in the 19th century. Since then, a wide variety of dissection techniques have been introduced. The water-jet dissector technique is a new selective dissection technique which is fast and oncological safe and
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Open Hepatic Transection Using Water-Jet Dissector Kerstin Huepgens, Denis Ehrl and Horst-Guenter Rau
7.1
Principles of Dissection
The liver consists of a three-dimensional network of afferent and efferent duct and vessel systems. Because of the higher content of collagen and elastin, these duct and vessel systems differ essentially in their structure and resistance from the liver parenchyma. Due to these physical properties, it is possible to release and dissect the duct and vessel systems mechanically from the liver parenchyma [1]. Dissection techniques which take advantage of these anatomic conditions are called selective; these include blunt dissection, the CUSA technique, and water-jet dissection. The nonselective dissection techniques are the scalpel, scissor, linear stapler, high-frequency coagulation, the UltraCisionÒ, and the laser technique. These techniques do not discriminate between duct structures and parenchyma.
Electronic Supplementary Material The online version of this article
(doi:10.1007/978-88-470-2622-3_7) contains supplementary material which is available to authorized users. K. Huepgens (&) D. Ehrl H.-G. Rau Surgical Department of Visceral and Thoracic Surgery, Amper Klinikum Dachau, Krankenhaussstrasse 15, 85221 Dachau, Germany e-mail: [email protected] D. Ehrl e-mail: [email protected] H.-G. Rau e-mail: [email protected]
I. Di Carlo (ed.), Open, Laparoscopic and Robotic Hepatic Transection, DOI: 10.1007/978-88-470-2622-3_7, Ó Springer-Verlag Italia 2012
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Fig. 7.1 Liver resection with water-jet dissector
Using the water-jet dissector, the blood vessels and bile ducts are prepared and washed free of surrounding tissue with the help of precisely adjusted water pressure (Fig. 7.1). The water-jet dissector acts thereby like an intelligent knife. Depending on their size, the blood vessels and bile ducts can then be either coagulated or selectively treated using a ligature/clip. The aims of all these devices are reduction of intraoperative blood loss, avoidance of parenchymal trauma, and reduction of Pringle rate and operation time.
7.2
Device Description
Cutting with a high-pressure water jet was a development that was primarily used as an industrial technique. At pressure levels of about 20,000 bar, a water jet reaches supersonic speed at the tip of the nozzle, which enables effortless cutting of wood and even steel plates without development of heat [1]. For application in surgery, the nozzle tip and pressure parameters had to be adjusted to the structural properties of parenchymal organs. The first development was made by Papachristou and Bengmark [2, 3], who implemented the technology in experimental and clinical investigations. Simultaneously, the working group of Rau et al. refined this technique based on the results of in vitro and in vivo trials, and after improvement introduced it into clinical routine liver surgery in 1990. In experimental examinations, we found that pressure of 30–40 bar and nozzle
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