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Acta Neurochirurgica

Published in:

01-11-2009 | Experimental Research

First experimental results with a new waterjet dissector: Erbejet 2

Authors: C. A. Tschan, K. Tschan, J. K. Krauss, J. Oertel

Published in: Acta Neurochirurgica | Issue 11/2009

Abstract

Background

Waterjet dissection represents a useful technique for many surgical procedures. In this experimental study, the technical features and dissection qualities of the new Erbejet 2 with its new pump and nozzle applicator system are evaluated for its neurosurgical use compared to the established Helix Hydro-Jet.

Methods

One hundred twenty-six fresh cadaveric pig brains were simultaneously cut with the Helix Hydro-Jet and Erbejet 2. Different pressure levels were applied to cerebral tissue with and without meninges, cerebellum and brainstem. Additionally, dissection characteristics of various cutting media were investigated.

Findings

There was a nearly equal dissection quality at up to 10 bar of both instruments. In contrast to the Helix Hydro-Jet, Erbejet 2 application at higher pressures resulted in an almost linear increase of dissection depth with a small standard deviation. Smoother cutting margins and less foaming were found. Preserved vessels were observed with both devices. Hydroxyaethyl starch led, in contrast to Ringer's solution and isotonic saline solution, to increased dissection width and more foaming.

Conclusions

The new Erbejet 2 is more precise, with almost linear correlation of pressure and dissection depth compared to the Helix Hydro-Jet. Less foaming and the possible application of various separating media are a considerable advantage. All things considered, the new Erbejet 2 offers more options to enlarge the field of neurosurgical indications for waterjet dissection.

Corvin S, Sturm W, Schlatter E et al (2005) Laparoscopic retroperitoneal lymph-node dissection with the waterjet is technically feasible and safe in testis-cancer patient. J Endourol 19:823–826. doi:10.1089/end.2005.19.823 CrossRefPubMed

Geers P, Moesta KT, Yildirim C et al (2007) Urodynamic outcome of waterjet assisted total mesorectal excision. Br J Surg 94:1543–1547. doi:10.1002/bjs.5862 CrossRefPubMed

Gordon E, Parolini B, Abelson M (1998) Principles and microscopic confirmation of surface quality of two new waterjet-based microkeratomes. J Refract Surg 14:338–345PubMed

Honl M, Dierk O, Küster JR et al (2001) Water jet discotomy with microinvasive approach–in vitro testing and initial clinical aspects of a new procedure. Z Orthop Ihre Grenzgeb 139:45–51. doi:10.1055/s-2001-11870 CrossRefPubMed

Honl M, Rentzsch R, Lampe F et al (2000) Water jet cutting for bones and bone cement-parameter study of possibilities and limits of a new method. Biomed Tech (Berl) 45:222–227CrossRef

Hubert J, Mourey E, Suty JM et al (1996) Water-jet dissection in renal surgery: experimental study of a new device in the pig. Urol Res 24:355–359. doi:10.1007/BF00389793 CrossRefPubMed

Jakob S, Kehler U, Reusche E et al (2000) Endoscopic use of the water jet dissector in the cerebral ventricle system-an experimental study. Zentralbl Neurochir 61:14–21. doi:10.1055/s-2000-8260 CrossRefPubMed

Kaduk WM, Stengel B, Pohl A et al (1999) Hydro-jet cutting: a method for selective surgical dissection of nerve tissue. An experimental study on the sciatic nerve of rats. J Craniomaxillofac Surg 27:327–330. doi:10.1054/jcms.1999.0076

Kaduk WM, Wolf E, Metelmann HR (2005) Arthroscopic dorsal ligament plasty using a hydrojet knife in the TMJ. Mund Kiefer Gesichtschir 9:29–35. doi:10.1007/s10006-004-0573-5 CrossRefPubMed

10.

Kaehler GF, Sold MG, Fischer K et al (2007) Selective fluid cushion in the submucosal layer by water jet: advantage for endoscopic mucosal resection. Eur Surg Res 39:93–97. doi:10.1159/000099597 CrossRefPubMed

11.

Kockerling F, Yildirim C, Rose J et al (2004) Total mesorectal excision with the water-jet-dissection. Technique and results. Tech Coloproctol 8:217–225. doi:10.1007/s10151-004-0163-4 CrossRef

12.

Kuhlmann C, Pude F, Bishup C et al (2005) Evaluation of potential risks of abrasive water jet osteotomy in-vivo. Biomed Tech (Berl) 50:337–342. doi:10.1515/BMT.2005.047 CrossRef

13.

Lesurtel M, Selzner M, Petrowsky H et al (2005) How should transection of the liver be performed?: a prospective randomized study in 100 consecutive patients: comparing four different transection strategies. Ann Surg 242:814–823. doi:10.1097/01.sla.0000189121.35617.d7 CrossRefPubMed

14.

Lesser T (2000) Atypical lung parenchyma resection with the Hydro-Jet: initial experimental and clinical experiences. Chirurg 71:592. doi:10.1007/s001040050865 CrossRefPubMed

15.

Lipshitz I, Bass R, Loewenstein A (1996) Cutting the cornea with a waterjet keratome. J Refract Surg 12:184–186PubMed

16.

Lipshitz I, Bass R (1998) Waterjet microkeratome—to set the record straight. J Refract Surg 14:667–669PubMed

17.

Magritz R, Jurk V, Reusche E et al (2001) Water-jet dissection in parotid surgery: an experimental study in dogs. Laryngoscope 111:1579–1584. doi:10.1097/00005537-200109000-00016 CrossRefPubMed

18.

Nissen NN, Grewal N, Lee J et al (2007) Completely laparoscopic nonanatomic hepatic resection using saline-cooled cautery and hydrodissection. Am Surg 73:987–990PubMed

19.

Oertel J, Gen M, Krauss J et al (2006) The use of waterjet dissection in endoscopic neurosurgery? J Neurosurg 105:928–931. doi:10.3171/jns.2006.105.6.928 CrossRefPubMed

20.

Oertel J, Gaab MR, Knapp A et al (2003) Water jet dissection in neurosurgery: experimental results in the porcine cadaveric brain. Neurosurgery 52:153–159. doi:10.1097/00006123-200301000-00020 CrossRefPubMed

21.

Oertel J, Gaab MR, Piek J (2003) Waterjet resection of brain metastases—first clinical results with ten patients. Eur J Surg Oncol 29:407–414. doi:10.1053/ejso.2002.1428 CrossRefPubMed

22.

Oertel J, Gaab MR, Pillich DT et al (2004) Comparison of waterjet dissection and ultrasonic aspiration: an in vivo study in the rabbit brain. J Neurosurg 100:498–504CrossRefPubMed

23.

Oertel J, Gaab MR, Runge U et al (2005) Waterjet dissection versus ultrasonic aspiration in epilepsy surgery. Neurosurgery 56:142–146. doi:10.1227/01.NEU.0000144316.87764.13 CrossRefPubMed

24.

Oertel J, Gaab MR, Schiller T et al (2004) Towards waterjet dissection in neurosurgery: experimental in-vivo results with two different nozzle types. Acta Neurochir (Wien) 146:713–720

25.

Oertel J, Gaab MR, Warzok R et al (2003) Waterjet dissection in the brain: review of the experimental and clinical data with special reference to meningioma surgery. Neurosurg Rev 26:168–174PubMed

26.

Oertel J, Wagner W, Piek J et al (2004) Waterjet dissection of gliomas- experience with 51 procedures. Minim Invasive Neurosurg 47:154–159. doi:10.1055/s-2004-818512 CrossRefPubMed

27.

Papachristou DN, Barters R (1982) Resection of the liver with a water jet. Br J Surg 69:93–94. doi:10.1002/bjs.1800690212 CrossRefPubMed

28.

Penchev RD, Losanoff JE, Kjossev KT (1999) Reconstructive renal surgery using a water jet. J Urol 162:772–774. doi:10.1097/00005392-199909010-00040 CrossRefPubMed

29.

Piek J, Oertel J, Gaab MR (2002) Waterjet dissection in neurosurgical procedures: clinical results in 35 patients. J Neurosurg 96:690–696CrossRefPubMed

30.

Piek J, Wille C, Warzok R et al (1998) Waterjet dissection of the brain: experimental and first clinical results. J Neurosurg 89:861–864CrossRefPubMed

31.

Rau HG, Meyer G, Cohnert TU et al (1995) Laparoscopic liver resection with the water-jet dissector. Surg Endosc 9:1009–1012. doi:10.1007/BF00188462 CrossRefPubMed

32.

Rau HG, Schardey HM, Buttler E et al (1995) A comparison of different techniques for liver resection: blunt dissection, ultrasonic aspirator and jet-cutter. Eur J Surg Oncol 21:183–187. doi:10.1016/S0748-7983(95)90435-2 CrossRefPubMed

33.

Schmolke S, Pude F, Kirsch L et al (2004) Temperature measurements during abrasive water jet osteotomy. Biomed Tech (Berl) 49:18–21. doi:10.1515/BMT.2004.004 CrossRef

34.

Shekarriz B (2005) Hydro-Jet technology in urologic surgery. Expert Rev Med Devices 2:287–291. doi:10.1586/17434440.2.3.287 CrossRefPubMed

35.

Shekarriz B, Upadhyay J, Jewett MA (2004) Nerve-sparing retroperitoneal lymphadenectomy using hydro-jet dissection: initial experience. J Endourol 18:273–336. doi:10.1089/089277904773582895 CrossRefPubMed

36.

Shekarriz H, Shekarriz B, Kujath P et al (2003) Hydro-Jet-assisted laparoscopic cholecystectomy: a prospective randomized clinical study. Surgery 133:635–640. doi:10.1067/msy.2003.155 CrossRefPubMed

37.

Siegert R, Magritz R, Jurk V (2000) Water-jet dissection in parotid surgery–initial clinical results. Laryngorhinootologie 79:780–784. doi:10.1055/s-2000-9140 CrossRefPubMed

38.

Sold MG, Grobholz R, Post S et al (2008) Submucosal cushioning with water jet before endoscopic mucosal resection: Which fluids are effective? Surg Endosc 22:443–447. doi:10.1007/s00464-007-9449-8 CrossRefPubMed

39.

Spahn G, Frober R, Linss W (2006) Treatment of chondral defects by hydro jet. Results of a preliminary scanning electron microscopic evaluation. Arch Orthop Trauma Surg 126:223–227. doi:10.1007/s00402-005-0002-8

40.

Terzis AJ, Nowak G, Rentzsch O et al (1989) A new system for cutting brain tissue preserving vessels: water jet cutting. Br J Neurosurg 3:361–366. doi:10.3109/02688698909002816 CrossRefPubMed

41.

Tschan CA, Gaab MR, Krauss JK et al (2008) Waterjet dissection of the vestibulocochlear nerve: an experimental study. J Neurosurg (Oct):3. Epub ahead of print

42.

Une Y, Uchino J, Shimamura T et al (1996) Water jet scalpel for liver resection in hepatocellular carcinoma with or without cirrhosis. Int Surg 81:45–48PubMed

43.

Wilhelm F, Holtkamp A, Darman J et al (1998) Potential of the water jet in cataract surgery. Ophthalmologe 95:721–724. doi:10.1007/s003470050342 CrossRefPubMed

44.

Wilhelm F, Holtkamp A, Duncker GI et al (2002) Phacoemulsification of human lens nucleus with a water jet. Ophthalmologe 99:286–288. doi:10.1007/s003470100502 CrossRefPubMed

45.

Wilhelm F, Holtkamp A, Theurer A et al (1999) Examination of resistance of the lens capsule against the waterjet. Ophthalmologe 96:640–642. doi:10.1007/s003470050466 CrossRefPubMed

46.

Wu YW, Jian YP, Liang JS et al (2006) The treatment of intrahepatic calculosis by applying helix hydro-jet lithotripsy under video choledochoscope: a report of 30 cases. Langenbecks Arch Surg 391:355–358. doi:10.1007/s00423-006-0058-0 CrossRefPubMed

47.

Bähren M, Bätzel A, Gösch M et al (2008) Das Einsparpotenzial innovativer Medizin-technik im Gesundheitswesen 2008. www.spectaris.de/downloads/presse/innovationsforum_2008/231008_Einsparpotenzial_2008.pdf, ISBN 978-3-941502-02-4; 1. Auflage/Berlin, Oktober 2008, SS. 31-36

Title: First experimental results with a new waterjet dissector: Erbejet 2
Authors: C. A. Tschan
K. Tschan
J. K. Krauss
J. Oertel
Publication date: 01-11-2009
Publisher: Springer Vienna
Published in: Acta Neurochirurgica / Issue 11/2009
Print ISSN: 0001-6268
Electronic ISSN: 0942-0940
DOI: https://doi.org/10.1007/s00701-009-0333-2

At a glance: The STEP trials

Springer Medicine

First experimental results with a new waterjet dissector: Erbejet 2

Abstract

Background

Methods

Findings

Conclusions

At a glance: The STEP trials

Springer Medicine

Abstract

Background

Methods

Findings

Conclusions

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