Nerve-sparing retroperitoneal lymphadenectomy using hydro-jet dissection: initial experience

Journal of Endourology
Bijan ShekarrizMichael A S Jewett

Abstract

Nerve-sparing retroperitoneal lymphadenectomy (RPL) is performed in a significant number of patients to preserve ejaculation after treatment for testicular cancer. Identification and preservation of the sympathetic nerves may be challenging. Hydro-Jet technology has been utilized for various surgical applications. A small high-pressure stream of water is used to delineate surgical planes, with preservation of vascular and neural structures. We have examined the utility of this technology for RPL in a porcine model and in human subjects. A Helix Hydro-Jet device (Erbe, USA) was used for all procedures. A high-pressure water-jet stream is directed through a small nozzle with a 120-microm inner radius for soft-tissue dissection. The upper pressure limit (range 0-2175 psi) is set using a digital monitor. The jet is initiated using a foot pedal, and the actual pressure is monitored. A pressure of 360 to 400 psi was used for experimental studies, which was decreased to 255 to 300 psi for human use. Three pigs underwent RPL using this technique. Subsequently, RPL was performed in five men with testicular cancer, being primary in two and postchemotherapy in three. The primary diagnosis was seminoma in one and non-seminomatous cancer in...Continue Reading

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Citations

Oct 7, 2008·Journal of Neurosurgery·Christoph TschanJoachim Oertel
May 1, 2009·Acta neurochirurgica·C A TschanJ Oertel
Nov 18, 2005·Expert Review of Medical Devices·Bijan Shekarriz
Jul 3, 2021·International Journal of Molecular Sciences·Walter LinzenboldMarkus D Enderle

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