Open Hepatic Transection Using Water-Jet Dissector

Abstract

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.