Open Hepatic Transection Using Water-Jet Dissector
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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.
KeywordsDissection Technique Laparoscopic Hepatobiliary Surgery Handpiece Extended Liver Resection Bile Duct Leaks
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