Waterjet dissection of the brain: experimental and first clinical results

Abstract

Control of bleeding during dissection is a problem that is still not completely resolved in neurosurgical procedures. To overcome this problem in some settings, the authors, in close collaboration with their institution, developed a new device for blunt dissection of brain tumors that is based on a waterjet technique. This report describes their first experimental and clinical experience with this new method. Numerous cutting experiments were performed in porcine cadaver brains. The best results were obtained using pressures from 4 to 6 bars with a 100-microm tip, which produced very small, precise cuts. Histological evaluation showed no disruption or vacuolization of the surrounding tissue. The authors have used the new device in nine patients (seven with gliomas and two undergoing temporal lobe resections for epilepsy), and no complications have been observed. The waterjet device allowed dissection of the brain tissue while even small exposed vessels were spared injury. The instrument was found to be easy to use. Future investigations will concentrate on adapting this new method to endoscopic surgery and evaluating fluids with low surface tension to avoid foaming and bubbling during open surgery.

Holmium:YAG Laser-Induced Liquid Jet Dissector: A Novel Prototype Device for Dissecting Organs without Impairing Vessels

“…Histology revealed no degenerative or necrotic damage on the surface cut with this device. This result is very similar to those obtained with the other water-jet devices [14,17,19]; however, our device can eliminate the disadvantages associated with the former, such as obscuration of the operative field and the splashing of bloody fluid, thanks to its pulsed operation. Moreover, while it has been reported that the slight delay between switching on such devices and the projection of the fluid was of minor inconvenience [14], our device possesses an even smaller time delay because the jet-driving source ± that is, the tip of the optical fiber ± exists in the distal region of the nozzle.…”

The treatment of intrahepatic calculosis by applying helix hydro-jet lithotripsy under video choledochoscope: a report of 30 cases

“…In 1982, waterjet was used in medical field. It can effectively dissect liver, kidney, and brain tissues [13]. Cesarani et al [14] invented a kind of high frequency pulse "waterjet"(hydrojet), conjuncted with application of fiber endoscope, could remove large stone, and also clean fragmented stone.…”

Tonsillektomie in Hydrodissektionstechnik

“…15 Jah ren ein ge setzt [1,17,20,34]. Die Hydro dis sek ti ons tech nik hat sich hier bei als blu tungs ar mes und ge we be s e lek ti ves Verfah ren vor al lem in der Ab do mi nal chir urgie, der Or tho pä die, der Op thal mo lo gie, der Neu ro chir ur gie und der Uro lo gie bewährt [3,4,9,19,36,37,49,51,52,53].…”