Shekarriz B, Shekarriz H, Upadhyay J, Wood D P, Bruch H P
Department of Urology, Wayne State University School of Medicine, Detroit, Michigan 48201, USA.
Urology. 1999 Dec;54(6):964-7. doi: 10.1016/s0090-4295(99)00345-3.
The Hydro-Jet technique has been used to cut various industrial materials. In the medical field, this technique has been successfully used for selective dissection of the parenchyma of organs such as the liver. Recently, this technique was successfully used for laparoscopic cholecystectomy in humans. We developed a new Hydro-Jet probe and a technique of Hydro-Jet dissection during laparoscopic nephrectomy (LN) in a porcine model and compared the results with those of conventional laparoscopy.
Fourteen pigs underwent unilateral LN using the Hydro-Jet and a conventional LN on the contralateral side. A Muritz 1000 Hydro-Jet generator was used. An adjustable water pressure gauge allowed manual control up to a maximum of 30 atm, and coagulation was applied by way of a bipolar thermoapplicator. The bent end of the probe allowed both blunt dissection and concomitant high-pressure water application. Results were compared with regard to ease of anatomic dissection, complications, and operative time between the two techniques.
LN was successful in all animals with no conversion to open surgery. The dissector allowed anatomic planes to be created in a relatively bloodless field, and continuous water flow allowed a clear view for the operator. The high-pressure stream resulted in excellent dissection of adventitial and soft tissue adjacent to vascular structures, with complete preservation of vessels and ureter for selective ligation. The dissection time was shortened (mean 27 minutes for the Hydro-Jet versus 40 minutes for the conventional technique).
To our knowledge, we describe the first report of Hydro-Jet dissection for LN as an alternative to the conventional technique. The improved anatomic dissection may decrease complications. Moreover, shorter operating times were achieved, which may result in cost savings. Further studies in humans are necessary to investigate this technique.
水刀技术已被用于切割各种工业材料。在医学领域，该技术已成功用于肝脏等器官实质的选择性解剖。最近，该技术在人类腹腔镜胆囊切除术中也取得了成功。我们在猪模型中开发了一种新的水刀探头以及腹腔镜肾切除术（LN）过程中的水刀解剖技术，并将结果与传统腹腔镜手术进行比较。
14头猪接受了单侧LN手术，一侧使用水刀技术，另一侧采用传统LN手术。使用Muritz 1000水刀发生器。可调水压计允许手动控制，最大压力可达30个大气压，并通过双极热 applicator 进行凝血。探头的弯曲端既可以进行钝性解剖，又能同时施加高压水。比较了两种技术在解剖的难易程度、并发症和手术时间方面的结果。
所有动物的LN手术均成功，无需转为开放手术。解剖器能够在相对无血的视野中创建解剖平面，持续的水流使术者视野清晰。高压水流能够出色地解剖血管结构周围的外膜和软组织，同时完整保留血管和输尿管以便进行选择性结扎。解剖时间缩短（水刀组平均为27分钟，传统技术组为40分钟）。
据我们所知，我们首次报道了水刀解剖用于LN作为传统技术的替代方法。改进的解剖方式可能会减少并发症。此外，手术时间缩短，可能会节省成本。有必要在人体中进行进一步研究以探究该技术。
