Hydro-Jet Assisted Laparoscopic Cholecystectomy: Initial Experience in a Porcine Model

BACKGROUND AND OBJECTIVES Hydro-Jet technology has long been used for cutting various materials like metal and wood in the industrial field. In the medical field, this technology has been applied successfully for selective cutting of the parenchyma of the liver. However, to our knowledge, no data exist on the use of the Hydro-Jet technique for laparoscopic cholecystectomy. The purpose of this study was to evaluate a new dissection technique using a high-pressure water stream (Hydro-Jet) and a new dissection probe for laparoscopic cholecystectomy. METHODS Thirty pigs underwent laparoscopic cholecystectomy. Pigs were randomized to receive either the conventional or Hydro-Jet assisted dissection technique. The feasibility of this technique and the features of surgical dissection were evaluated and compared between the 2 groups. RESULTS Laparoscopic cholecystectomy was successful in all animals with no need for conversion to open surgery. The mean operative time was 28 and 36 minutes for Hydro-Jet versus conventional dissection, respectively. Complications using the Hydro-Jet and conventional techniques included 6% and 20% gallbladder perforation and 6.5% and 13% liver laceration, respectively. The use of the Hydro-Jet for cholecystectomy had clear technical advantages over conventional dissection. The Hydro-Jet resulted in a selective dissection of fibrous and connective tissue preserving blood vessels for later ligation. Therefore, the dissection was performed in a relatively bloodless field. The ease of dissection using the new bent tipped dissector represents another advantage. Finally, the continuous water flow allowed a clear view for the operator. CONCLUSIONS This study shows that Hydro-jet dissection represents an excellent alternative to the conventional technique for laparoscopic cholecystectomy. The improved anatomical dissection combined with an almost bloodless operating field secondary to continuous water flow may decrease dissection-related complications.