Hydro-Jet dissection for laparoscopic nephrectomy: A new technique

Objectives. 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. Re cently, this technique was successfully used for laparoscopic cholecystecto my in humans. We developed a new Hydro-Jet probe and a technique of Hydro-J et dissection during laparoscopic nephrectomy (LN) in a porcine model and c ompared the results with those of conventional laparoscopy. Methods. Fourteen pigs underwent unilateral LN using the Hydro-Jet and a co nventional 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 thermoa pplicator. The bent end of the probe allowed both blunt dissection and conc omitant high-pressure water application. Results were compared with regard to ease of anatomic dissection, complications, and operative time between t he two techniques. Results. LN was successful in all animals with no conversion to open surger y. The dissector allowed anatomic planes to be created in a relatively bloo dless field, and continuous water flow allowed a clear view for the operato r. The high-pressure stream resulted in excellent dissection of adventitial and soft tissue adjacent to vascular structures, with complete preservatio n of vessels and ureter for selective ligation. The dissection time was sho rtened (mean 27 minutes for the Hydro-Jet versus 40 minutes for the convent ional technique). Conclusions. To our knowledge, we describe the first report of Hydro-Jet di ssection for LN as an alternative to the conventional technique. The improv ed anatomic dissection may decrease complications. Moreover, shorter operat ing times were achieved, which may result in cost savings. Further studies in humans are necessary to investigate this technique. (C) 1999, Elsevier S cience Inc.