Open Hepatic Transection Using Water-Jet Dissector

  • Kerstin HuepgensEmail author
  • Denis Ehrl
  • Horst-Guenter Rau


The first planned hemihepatectomy was performed in the 19th century. Since then, a wide variety of dissection techniques have been introduced. The water-jet dissector technique is a new selective dissection technique which is fast and oncological safe and can be used in open and laparoscopic hepatobiliary surgery. The water-jet dissector is a helpful tool in dissecting parenchymatous organs such as the liver. Using the water-jet technique, the blood vessels and bile ducts are prepared and washed free of surrounding tissue with the help of precisely adjusted water pressure (30–40 bar). The water-jet dissector acts like an intelligent knife. After dissection, the blood vessels and bile ducts can be clipped or coagulated. Since 2010, we have used a handpiece with additional application of high-frequency current. With this method, it is possible to coagulate small vessels and bile ducts instead of clipping. In oncological surgery, the water-jet dissector proved to have no negative influence on long-term survival. In the last 4 years, we have carried out 178 liver resections, employing the Pringle maneuver in only 1 case. So, the rate was reduced from 6 % to 0.6 %. With this technique, it is possible to reduce the Pringle rate, operating time, blood loss, and transfusion rate significantly.

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  1. 1.
    Rau HG, Schauer R, Pickelmann S, Meyer BCM, Angele MK, Zimmermann A, Meimarakis G, Heizmann O, Schildberg FW (2001) Dissektionstechniken in der Leberchirurgie. Chirurg 73:105–112CrossRefGoogle Scholar
  2. 2.
    Bengmark S (1987) Leberchirurgie. Chir Gastroenterol 3:5–11Google Scholar
  3. 3.
    Papachristou DN, Barters R (1982) Resection of the liver with a water jet. Br J Surg 69:93–94PubMedCrossRefGoogle Scholar
  4. 4.
    Rau HG, Arnold H, Schildberg FW (1990) Schneiden mit dem Wasser-Strahl (Jet-Cutting)–eine Alternative zum Ultraschallaspirator? Chirurg 61:735–738PubMedGoogle Scholar
  5. 5.
    Rau HG, Wichmann M, Schinkel S, Buttler E, Pickelmann S, Schauer R (2001) Surgical techniques in hepatic resections: ultrasonic aspirator versus jet cutter–a prospective randomized clinical trial. Zentralbl Chir 126:586–590PubMedCrossRefGoogle Scholar
  6. 6.
    Rau HG, Zimmermann A, Wardemann C, Schildberg FW (2003) Standards of surgical techniques in liver metastases. Chir Gastroenterol 19:333–339CrossRefGoogle Scholar

Copyright information

© Springer-Verlag Italia 2012

Authors and Affiliations

  • Kerstin Huepgens
    • 1
    Email author
  • Denis Ehrl
    • 1
  • Horst-Guenter Rau
    • 1
  1. 1.Surgical Department of Visceral and Thoracic SurgeryAmper Klinikum DachauDachauGermany

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