Hanaki T, Tsuda A, Sunaguchi T, Goto K, Morimoto M, Murakami Y, Kihara K, Matsunaga T, Yamamoto M, Tokuyasu N, Sakamoto T, Hasegawa T, Fujiwara Y. Influence of the water jet system vs cavitron ultrasonic surgical aspirator for liver resection on the remnant liver. World J Clin Cases 2022; 10(20): 6855-6864 [PMID: 36051129 DOI: 10.12998/wjcc.v10.i20.6855]
Corresponding Author of This Article
Takehiko Hanaki, MD, PhD, Assistant Professor, Division of Gastrointestinal and Pediatric Surgery, Department of Surgery, Tottori University Faculty of Medicine, 36-1, Nishi-Cho, Yonago 683-8504, Tottori, Japan. hanaki-ttr@umin.ac.jp
Research Domain of This Article
Surgery
Article-Type of This Article
Observational Study
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Takehiko Hanaki, Ayumi Tsuda, Teppei Sunaguchi, Keisuke Goto, Masaki Morimoto, Yuki Murakami, Kyoichi Kihara, Tomoyuki Matsunaga, Manabu Yamamoto, Naruo Tokuyasu, Teruhisa Sakamoto, Toshimichi Hasegawa, Yoshiyuki Fujiwara, Division of Gastrointestinal and Pediatric Surgery, Department of Surgery, Tottori University Faculty of Medicine, Yonago 683-8504, Tottori, Japan
Author contributions: Hanaki T designed the study and drafted the initial manuscript; Tsuda A performed the all statistical analysis; Sunaguchi T, Goto K, Morimoto M, Murakami Y, Kihara K, Matsunaga T, Yamamoto M and Tokuyasu N participated in the acquisition and analysis of data; Hanaki T and Sakamoto T performed the surgery; Hasegawa T and Fujiwara Y revised the article critically for important intellectual content.
Institutional review board statement: The study was reviewed and approved by the institutional review board of Tottori University, Faculty of Medicine (approval No. 21A081).
Informed consent statement: The need for patients’ informed written consent was waived due to the retrospective nature of the study.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Data sharing statement: No additional data are available.
STROBE statement: The authors have read the STROBE Statement-checklist of items, and the manuscript was prepared and revised according to the STROBE Statement-checklist of items.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Takehiko Hanaki, MD, PhD, Assistant Professor, Division of Gastrointestinal and Pediatric Surgery, Department of Surgery, Tottori University Faculty of Medicine, 36-1, Nishi-Cho, Yonago 683-8504, Tottori, Japan. hanaki-ttr@umin.ac.jp
Received: November 8, 2021 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
ARTICLE HIGHLIGHTS
Research background
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.
Research motivation
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.
Research objectives
To investigate and compare the impact of the WJ and CUSA methods on the residual liver cut surface.
Research methods
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.
Research results
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].
Research conclusions
Hepatectomies using WJ showed significantly thinner low-contrast areas in the dissected plane than CUSA.
Research perspectives
The WJ hepatectomy may contribute to safe liver resection in terms of minor thermal damage on the residual liver and avoiding postoperative liver failure.
