Principles Of Dissection

Figure 3 demonstrates the principle of retroperitoneal dissection using hydro-jet technique. Similar principles apply to resection of renal parenchyma.

Retroperitoneal Dissection Using Hydro-Jet Technique

■ Saline application results in expansion of the retroperitoneal space and creation of surgical planes (Fig. 3A and B).

■ The thin stream of high-pressure saline allows selective separation of surrounding connective tissue components from the vessels and nerves.

■ Utilizing a specific range, saline displaces fibrous and collagenous tissue leaving the vessels and nerves intact without injury due to tissue selectivity (Fig. 3C).

■ Combined hydro-jet dissection and blunt dissection with the angled tip dissector allow dissection of vital structures such as nerves and vessels (Fig. 3D).

■ The flow of saline allows a clear view for the operator.

During partial nephrectomy, the tissue selectivity allows precise cutting through the parenchyma with preservation of vessels and collecting system. These structures can then be selectively coagulated or ligated.

A theoretical question raised is the issue of dissemination of cancer cells while performing hydro-jet dissection for malignant disease. However, the application of saline is performed in the same surgical field as for conventional dissection and away from the pathology to be removed. Therefore, it is unlikely that saline application will result in cancer dissemination. At present, there are no reports of dissemination of cancer cells after various clinical applications.

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Reiropcriiotical —-soll I issue expansion


FIGURE3 ■ Schematic of the effects of the water jet using the Helix™ Hydro-Jet. (A) Retroperitoneal space prior to application of hydro-jet. (B) Application of saline to the retroperitoneal tissue in a linear fashion results in expansion of retroperitoneal soft tissue. (C) The vessels and nerves are preserved due to tissue selectivity. (D) Using sharp dissection with hydro-jet and blunt dissection with the angled tip probe, the nerve structures and blood vessels are identified, freed and isolated.

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