Use of water jet resection in organ-sparing kidney surgery

Abstract

Background and purpose: The morbidity of organ-sparing renal surgery is related to intraoperative hemorrhaging and secondarily to urinary fistulae and urinoma. Various tools have been developed for gentle transection and precise control of bleeding. Water jet technology is already established in clinical practice for surgery of the liver and other parenchymatous organs. We report our clinical experience with a new water jet resection device in kidney surgery and the histologic effects of water jet resection on kidney tissue.

Patients and methods: A series of 24 patients underwent open surgery for renal-cell carcinoma, nephrolithiasis, complicated cysts, or oncocytoma. In tumor patients, a partial nephrectomy; in two stone patients, a nephrolithotomy; and in the third stone patient, a lower-pole resection were performed. The cysts and the oncocytoma were enucleated in toto. In one patient, an endoscopic pyeloplasty was performed because of ureteropelvic stenosis. Tissue samples were investigated histologically using standard light microscopy after hematoxylin-eosin staining and compared with those subjected to thermal dissection techniques.

Results: The water jet produced a corridor in the desired dissection line without interfering with the intrarenal vessels and pelvicalical system. This way, precise hemostasis was possible, and damages to the surrounding tissue was avoided. Resection took between 14 and 40 minutes with minimal intraoperative blood loss. No significant postoperative complications occurred. Histologic evaluation demonstrated a sharp dissection line without thermal alterations or deep necrosis. Only a small disruption zone could be seen at the margins of the dissection.

Conclusions: Water jet resection is a gentle method for dissection of kidney tissue. Histologic examination confirmed minimal traumatic parenchymal alteration. In our opinion, the water jet dissector is a useful device for renal transection in organ-sparing kidney surgery.