Shekarriz Bijan, Upadhyay Jyoti, Jewett Michael A S
Division of Urology, Princess Margaret Hospital and the University Health Network, University of Toronto, Toronto, Ontario, Canada.
J Endourol. 2004 Apr;18(3):273-6. doi: 10.1089/089277904773582895.
Nerve-sparing retroperitoneal lymphadenectomy (RPL) is performed in a significant number of patients to preserve ejaculation after treatment for testicular cancer. Identification and preservation of the sympathetic nerves may be challenging. Hydro-Jet technology has been utilized for various surgical applications. A small high-pressure stream of water is used to delineate surgical planes, with preservation of vascular and neural structures. We have examined the utility of this technology for RPL in a porcine model and in human subjects.
A Helix Hydro-Jet device (Erbe, USA) was used for all procedures. A high-pressure water-jet stream is directed through a small nozzle with a 120-microm inner radius for soft-tissue dissection. The upper pressure limit (range 0-2175 psi) is set using a digital monitor. The jet is initiated using a foot pedal, and the actual pressure is monitored. A pressure of 360 to 400 psi was used for experimental studies, which was decreased to 255 to 300 psi for human use. Three pigs underwent RPL using this technique. Subsequently, RPL was performed in five men with testicular cancer, being primary in two and postchemotherapy in three. The primary diagnosis was seminoma in one and non-seminomatous cancer in four. The patient with seminoma had a residual mass after chemotherapy.
The procedures were completed successfully in all subjects. There were no intraoperative or postoperative complications. Hydro-Jet dissection permitted tissue selectivity, with preservation of vascular structures and sympathetic nerves. The soft tissue and lymphatics were removed with the high-pressure water stream assisted by blunt dissection. The nerve fibers were grossly resistant to the pressure used and were isolated individually. Dissection around the great vessels appeared to be safe, and no injury was observed with direct application of the jet. Lumbar arteries and veins and accessory vessels could be isolated safely. The estimated blood loss was minimal in animals and 300 to 800 mL in humans.
Hydro-Jet dissection demonstrated tissue selectivity using a pressure range of 255 to 300 psi in humans. The vascular structures and sympathetic nerves were preserved. Our initial experience with this device for nerve-sparing RPL is encouraging.
为使睾丸癌患者在治疗后仍能射精，大量患者接受了保留神经的腹膜后淋巴结清扫术（RPL）。识别和保留交感神经可能具有挑战性。水刀技术已应用于各种外科手术。一股细小的高压水流用于划分手术平面，同时保留血管和神经结构。我们在猪模型和人体受试者中研究了该技术用于RPL的效用。
所有手术均使用螺旋水刀装置（美国爱尔博公司）。一股高压水流通过内径为120微米的小喷嘴用于软组织分离。使用数字监视器设置压力上限（范围为0 - 2175磅力/平方英寸）。通过脚踏板启动水流，并监测实际压力。实验研究使用的压力为360至400磅力/平方英寸，用于人体时降至255至300磅力/平方英寸。三只猪使用该技术接受了RPL。随后，对五名睾丸癌男性患者进行了RPL，其中两名是原发性患者，三名是化疗后患者。原发性诊断为精原细胞瘤1例，非精原细胞瘤4例。精原细胞瘤患者化疗后有残留肿块。
所有受试者的手术均成功完成。无术中或术后并发症。水刀分离具有组织选择性，可保留血管结构和交感神经。在钝性分离辅助下，高压水流可去除软组织和淋巴管。神经纤维对所用压力具有明显抵抗力，可单独分离。大血管周围的分离似乎是安全的，直接应用水流未观察到损伤。腰动静脉和附属血管可安全分离。估计动物的失血量极少，人类为300至800毫升。
在人体中，水刀分离在255至300磅力/平方英寸的压力范围内显示出组织选择性。血管结构和交感神经得以保留。我们使用该装置进行保留神经的RPL的初步经验令人鼓舞。
