Water, a powerful tool in surgery

Abstract

Inflammation of the gallbladder, also known as acute cholecystitis, may be caused by infection and inflammation of the gallbladder wall due to bile stasis, with or without gallstones. It is one of the most common surgical procedures that are performed laparoscopically. Gangrenous gallbladders are one of the most difficult conditions to treat clinically and surgically, being the cause of many medical malpractice litigations. Gangrenous gallbladders constitute 15% of all laparoscopic surgeries, with the cost of these surgeries being approximately $48,000, compared to other laparoscopic gallbladder surgeries being around $7,000. Dr. Dinesh Vyas and his team have worked together to develop the novel HydroLap, which is a tool that utilizes hydrodissection technology during laparoscopic cholecystectomies to remove the delicate, dead tissue while preserving the healthy tissue of surrounding structures. This decade-long journey began in the operating room and resulted in an innovation that is awaiting Food and Drug Administration (FDA) approval for use in 2023.

Keywords: Medical procedure; Surgical procedure; Therapeutic procedure.

Illustration of hydrodissection being utilized to remove a gangrenous gallbladder

Illustration demonstrating the difference in clarity of anatomy during surgery for Gangrenous gall bladder with the standard and novel hydrodissector technology A more clarity in visualization leads to shorter operating time with less bleeding as well as more completion of surgery. (A) Blunt dissection does not provide sufficient visualization of the important structures in a laparoscopic cholecystectomy, resulting in an average operating time of 2:09 hours (172.1±28.1 min). This includes converting to open and/or incomplete surgeries. (B) Jet-streams of normal saline with hydrodissection results in dissection of the necrotic tissue without damaging healthy tissue in addition to improving visualization of the important structures in a laparoscopic cholecystectomy, resulting in an average operating time of 1:23 hours (83.6±4.9 min).

Innovative application of water jet in abdominal and thoracic tissue surgeries improve outcomes (A) Change in vessel radius results in an inverse change in velocity of the fluid moving through the vessel. (B) With the appropriate change in aperture, the jet stream pressure can cut into necrotic tissue without harming healthy tissue. (C) Change in the diameter of the aperture results in a change in jet stream pressure and velocity, enabling the jet stream to function as a knife.

Members of the team include (Left) Kayla Umemoto, (Middle) Wenjia Wang, and (Right) Dr. Dinesh Vyas