The water jet method has been used during hepatic resection. The instrument cuts the hepatic tissue with the high pressure of the fine water flow, while the exposed elastic intrahepatic vessels are spared injury. The jet cutter26,27,35 produces selective cutting, but the thermal methods cannot discriminate between the vessels and the parenchyma. The loosely connected parenchyma is washed away from the more resilient vessels by shooting a beam of NaCl through a 0.1 to 0.2 nozzle at pressures of 10 to 80 bar. The distance between jet and liver is 1.5 cm and is kept constant by using a suction device. A higher jet pressure is needed to cut the fibrotic hepatic parenchyma. In the case of normal liver, the intrahepatic vessels of more than 0.2 mm are well preserved.
The loss of blood during transaction of the hepatic parenchyma can be easily reduced with ajet pressure of 15 to 16kg/cm2. This preserves the fine vessels, more than 0.2 mm in diameter, without injury. When the same pressure is applied in the cutting of a cirrhotic liver, it takes a longer time compared with that of a non-cirrhotic normal liver parenchyma. A disadvantage is the formation of air bubbles, which obscure the operative field. In addition, after the vessels are isolated, conventional ligation or clipping is still required and is time consuming.
Was this article helpful?