The multimodal water jet dissector--a technology for laparoscopic liver surgery.

Unlabelled: In order to avoid laparotomy in patients with superficially and/or anatomically favourably located liver lesions, the feasibility of laparoscopic liver resection using an aqua jet was evaluated in 6 pigs. For this purpose a commercially available water jet dissector was adapted for laparoscopic use and modified to a multifunctional device providing aqua jet, suction and cautery. To improve laparoscopic vision during jet activity a hydrolaparoscope was used. The left lateral lobe was resected using clips for haemostasis only.

Results: All animals (34-55 kg, average 41 kg) survived the procedure. The blood loss at operation consisted of 225 ml (50-600 ml), the haematocrit 3.3% (1-8%). No bleeding or other complications were encountered postoperatively. The average weight of the specimens was 201 g (120-289 g).

Conclusions: Laparoscopic liver resection using an aqua jet is feasible. Safe haemostasis can be achieved with clips if the vessels are entirely freed with the jet before clipping.