[A new fluid-jet dissector in hepatobiliary surgery].

Increasing experience with major hepatic resections has stimulated the development of improved resectional techniques and tools. The authors describe a recently developed high pressure, high velocity water jet which offers significant advantages over previously developed methods like ultrasonic dissectors and low pressure water jet machines. The pressure of the system is significantly elevated (between 200 and 600 Bars) and the ejection speed is over 300 m/sec. although the flux remains low. It has been successfully used in 22 major hepatic resections (2 left hepatectomy, 4 extended left, 3 right, 8 extended right and 5 segmental resections) and also during 6 peripheral biliodigestive bypasses (3 segment III bypasses and 3 peripheral segment III bypasses). The blood loss was low and the visibility excellent. The amount of fluid required by the instrument was small reducing the risk of complications. Previous report demonstrated that the water jets are more effective when compared with ultrasound dissectors. The technical characteristic of the new high pressure water jet improves on those intrinsic qualities allowing a more rapid dissection of both fibrous and normal parenchyma and simplifying the use of the instrument. The authors conclude that the new high pressure, high velocity water jet is an effective tool for biliodigestive surgery.