Hydro-Jet assisted laparoscopic partial nephrectomy: Initial experience ina porcine model

Purpose: Hemostasis represents a challenge when performing laparoscopic par tial nephrectomy. Hydro-Jet cutting is an advanced technology that has been used to create an ultra-coherent water force that functions like a sharp k nife. In the surgical field, it has mainly been used for liver surgery and initial clinical experience with laparoscopic cholecystectomies has been fa vorable. This technique allowed selective parenchymal cutting with preserva tion of vessels and bile ducts. We describe a novel Hydro-Jet assisted diss ection technique for laparoscopic partial nephrectomy in a porcine model. Materials and Methods: Ten partial nephrectomies were performed in 5 pigs u sing a Muritz 1000 (Euromed Medizintechnik, A. Pein, Schwerin, Germany) Hyd ro-Jet generator. A thin stream of ultra coherent fluid is forced at a high velocity through a small nozzle, A modified probe allows both blunt dissec tion concomitantly with high-pressure water application. Coagulation can be applied via a bipolar thermoapplicator as needed. Results: Laparoscopic partial nephrectomy was successful in all animals. Wa ter-jet cutting through the parenchyma was virtually bloodless and:preserve d the vasculature and the collecting system. The vessels were then ligated or coagulated under direct vision. The continuous water flow established a bloodless operating field and a clear view for the surgeon. The mean dissec tion time and warm ischemia time were 45 +/- 9 and 17 +/- 3 minutes, respec tively. Conclusions: This preliminary study supports the suitability of this techni que for laparoscopic partial nephrectomy to improve hemostasis. The improve d anatomical dissection and hemostasis may further decrease morbidity and o perative time. Further studies are underway to compare this technique with laser coagulation for laparoscopic partial nephrectomy.