Published online Jul 16, 2022. doi: 10.12998/wjcc.v10.i20.6855
Peer-review started: November 8, 2021
First decision: April 19, 2022
Revised: April 23, 2022
Accepted: May 27, 2022
Article in press: May 27, 2022
Published online: July 16, 2022
Processing time: 238 Days and 21.3 Hours
Reports on the usefulness of the water jet (WJ) technique as a relatively new liver resection method have been increasing. Although there have been many reports on the effectiveness of WJ in improving blood loss and operation time, there has been no evaluation of its effect on the hepatic dissection plane.
Our department has used the cavitron ultrasonic surgical aspirator (CUSA) method for liver parenchymal sections for many years; however, we recently introduced the WJ for liver resection. Based on this experience, we observed the liver section planes of the WJ and CUSA methods, and we had the impression that the WJ method had less thermal degeneration on the dissected plane. Although less degeneration of the residual liver may lead to preservation of residual liver function and further contribute to avoiding postoperative liver failure, there are no previous reports evaluating the denaturation of the liver dissected cross-section by the method of liver dissection.
To investigate and compare the impact of the WJ and CUSA methods on the residual liver cut surface.
Forty cases of liver resection with CUSA and 24 cases of liver resection with WJ who underwent liver resection between 2019 and 2021 and had contrast-enhanced computed tomography (CT) during postoperative hospitalization were included in this retrospective study. Furthermore, the postoperative CT scans were used to assess the cut surface length of the remnant liver and the degenerative thickness of the areas with a reduced contrast effect in the dissected plane.
On CT scan, the median areas of denaturation in the liver dissection planes were 522 (range: 109.5-1242) mm2 in the CUSA group and 324 (range: 93.6-1529) mm2 in the WJ group. The area did not significantly differ between the two groups; however, the denaturation thickness of the WJ group was significantly lower than that of the CUSA group [5.8 (range: 0.7-11.1) mm vs 3.3 (range: 1.7-10.4), P < 0.001].
Hepatectomies using WJ showed significantly thinner low-contrast areas in the dissected plane than CUSA.
The WJ hepatectomy may contribute to safe liver resection in terms of minor thermal damage on the residual liver and avoiding postoperative liver failure.