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Multi-stream saline-jet dissection using a simple irrigation system defines difficult tissue planes.

Durai R, Ng PC - JSLS (2010 Jan-Mar)

Bottom Line: In effect, this is the standard setup generally used for irrigation.The disadvantage is that with tissues saturated with saline it becomes more difficult to use diathermy hemostasis.Care has to be exercised in monitoring the temperature and volume of the fluid used.

View Article: PubMed Central - PubMed

Affiliation: Minimally Invasive Surgery Unit, Department of Surgery, University Hospital Lewisham, London, United Kingdom. dr_durai@yahoo.com

ABSTRACT

Introduction: Single-stream hydro-jet dissection is increasingly used in various laparoscopic procedures, but its use requires special equipment. We describe a simple method for using an irrigation system for saline-jet tissue dissection as a useful adjunct prior to adhesiolysis.

Material and methods: Intraabdominal adhesions prolong laparoscopic procedures, because tissue planes are difficult to identify. We performed multi-jet saline dissection (MSSJ) between 2000 and 2009 in more than 500 patients during laparoscopy involving hernias, gallbladders, appendices, and intestinal obstructions. We use a standard suction irrigation probe, which is attached to a 1-liter saline bag with an inflatable cuff around to create a pressure of 250mm Hg to 300mm Hg. In effect, this is the standard setup generally used for irrigation. After using saline dissection, tissue planes can be better defined and the structures can then be separated.

Result and discussion: Using this method, we have successfully identified tissue planes in spite of dense adhesions, and our conversion rates to open have been reduced dramatically. This method is relatively safer than other modalities of tissue dissection, such as diathermy, ultrasonic, blunt or sharp dissection. The disadvantage is that with tissues saturated with saline it becomes more difficult to use diathermy hemostasis. Care has to be exercised in monitoring the temperature and volume of the fluid used.

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MSSJ dissection during subhepatic appendectomy.
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Related In: Results  -  Collection

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Figure 4: MSSJ dissection during subhepatic appendectomy.

Mentions: We have found MSSJ useful in difficult cases where the appendix is in subhepatic (Figure 4) or retrocecal positions. The appendix is held at the tip with endo-Babcock forceps, and saline stream under pressure is used to create water logging of the tissues. The irrigation system probe is used to apply countertraction at the appendicular mesentery. Then appendix is skeletonized by using bipolar or tripolar diathermy.


Multi-stream saline-jet dissection using a simple irrigation system defines difficult tissue planes.

Durai R, Ng PC - JSLS (2010 Jan-Mar)

MSSJ dissection during subhepatic appendectomy.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3021299&req=5

Figure 4: MSSJ dissection during subhepatic appendectomy.
Mentions: We have found MSSJ useful in difficult cases where the appendix is in subhepatic (Figure 4) or retrocecal positions. The appendix is held at the tip with endo-Babcock forceps, and saline stream under pressure is used to create water logging of the tissues. The irrigation system probe is used to apply countertraction at the appendicular mesentery. Then appendix is skeletonized by using bipolar or tripolar diathermy.

Bottom Line: In effect, this is the standard setup generally used for irrigation.The disadvantage is that with tissues saturated with saline it becomes more difficult to use diathermy hemostasis.Care has to be exercised in monitoring the temperature and volume of the fluid used.

View Article: PubMed Central - PubMed

Affiliation: Minimally Invasive Surgery Unit, Department of Surgery, University Hospital Lewisham, London, United Kingdom. dr_durai@yahoo.com

ABSTRACT

Introduction: Single-stream hydro-jet dissection is increasingly used in various laparoscopic procedures, but its use requires special equipment. We describe a simple method for using an irrigation system for saline-jet tissue dissection as a useful adjunct prior to adhesiolysis.

Material and methods: Intraabdominal adhesions prolong laparoscopic procedures, because tissue planes are difficult to identify. We performed multi-jet saline dissection (MSSJ) between 2000 and 2009 in more than 500 patients during laparoscopy involving hernias, gallbladders, appendices, and intestinal obstructions. We use a standard suction irrigation probe, which is attached to a 1-liter saline bag with an inflatable cuff around to create a pressure of 250mm Hg to 300mm Hg. In effect, this is the standard setup generally used for irrigation. After using saline dissection, tissue planes can be better defined and the structures can then be separated.

Result and discussion: Using this method, we have successfully identified tissue planes in spite of dense adhesions, and our conversion rates to open have been reduced dramatically. This method is relatively safer than other modalities of tissue dissection, such as diathermy, ultrasonic, blunt or sharp dissection. The disadvantage is that with tissues saturated with saline it becomes more difficult to use diathermy hemostasis. Care has to be exercised in monitoring the temperature and volume of the fluid used.

Show MeSH
Related in: MedlinePlus