Waterjet Dissection for Partial Nephrectomy Without Hilar Clamping in a Porcine Model

Abstract

Hilar clamping is typically used in partial nephrectomy to control hemorrhage, which may damage the renal tissue under warm ischemia conditions. The purpose of this study was to evaluate waterjet technology in partial nephrectomy without renal hilar vascular control in a porcine model. Bilateral partial nephrectomy using waterjet was performed in 8 pigs (16 kidneys: 8 for wedge resections, 8 for pole resections). The operations were performed successfully in all animals. The mean dissection time was 30.6 6 2.9 minutes for pole resections and 36.5 6 3.5 minutes for wedge resections. The mean blood loss was 51.6 6 11.7 mL for pole resections and 38.7 6 9.2 mL for wedge resections. The novel waterjet technique provided precise and effective hydrodissection of the kidney, avoiding damage to the vascular structures or collecting system.Key words: Partial nephrectomy -Waterjet dissection -Animal experiment K idney cancer is one of the most common cancers in the urinary system. More and more asymptomatic small renal tumors are diagnosed because of the wide use of imaging technologies. 1For decades, radical nephrectomy was considered the gold standard treatment for localized renal cancer. In recent years, nephron-sparing procedures (partial nephrectomy) have been demonstrated to have similar outcomes to traditional radical nephrectomy for small renal tumors.2 However, partial nephrectomy is a challenging operation with a high risk of parenchymal bleeding and damage to the collecting system. Renal hilar vessel clamping is still the first choice to minimize the parenchymal bleeding. Partial nephrectomy is then completed expeditiously under warm ischemia with limited time Waterjet dissection has been used for selective dissection of the parenchyma of liver, 4-6 pancreatic necrosectomy, 7 and endoscopic submucosal dissection for gastrointestinal tumors. [8][9][10] In this study, we investigated whether waterjet resection is applicable or feasible for partial nephrectomy without temporary ischemia in a porcine model. Materials and MethodsThe waterjet dissector Waterjet surgery, a new form of dissection that has been successfully used for several years, separates the different tissue types with their varying elasticity and firmness with the help of precisely adjusted water pressure.5-7 The kinetic energy of the waterjet carefully separates the layers of tissue.5-7 The ERBEJET 2 (ERBE Elektromedizin GmbH, Tübingen, Germany) is a waterjet surgical device for the preparation and separation of tissue, suitable for preserving layering. The selective separation property of water supports the surgeon in the dissection of parenchymal tissue (e.g., liver, spleen, kidney, brain) while sparing blood vessels and nerves. By using ERBEJET2, blood vessels and nerves are preserved by using predefined water pressures, while the surrounding tissue is selectively dissected. Furthermore, the ERBEJET2 is compatible with the advanced electrosurgical controller ERBE VIO (ERBE Elektromedizin). Animal experimentsEight pigs, weighing approximately 40 ...