Anatomic Indications for Using Actuator-driven Pulsed Water Jet for Hepatectomy

Area of Science:

• Hepatobiliary surgery
• Surgical oncology
• Minimally invasive surgery

Background:

• Clamp crushing and Cavitron ultrasonic surgical aspirator (CUSA) are standard for liver transection.
• Actuator-driven pulsed water jet (ADPJ) offers high tissue selectivity but requires further safety evaluation in patients.
• Optimal indications and comparative performance of ADPJ need clarification.

Purpose of the Study:

• To evaluate the safety and efficacy of the actuator-driven pulsed water jet (ADPJ) in liver resections.
• To define the best indications for ADPJ use in complex cases.
• To compare ADPJ performance against traditional liver transection methods.

Main Methods:

• The actuator-driven pulsed water jet (ADPJ) was used selectively from December 2017 in demanding cases involving tumors near major vessels.
• ADPJ was avoided in patients with liver cirrhosis or hard hepatic parenchyma.
• Six cases meeting strict criteria were analyzed.

Main Results:

• All six cases achieved R0 resection, indicating complete tumor removal.
• Tumors were often in close proximity (0 mm) or attached to major vessels over a significant length (26 mm).
• Median operation time was 559 minutes with a median blood loss of 620 mL.

Conclusions:

• Actuator-driven pulsed water jet (ADPJ) facilitates R0 hepatectomy in challenging liver resections.
• The primary indication for ADPJ is tumors with long-distance adherence or close proximity to critical vessels.
• ADPJ demonstrates effectiveness in preserving vessels and achieving oncologic goals in selected patients.