J Neurol Surg A Cent Eur Neurosurg
DOI: 10.1055/a-1962-1345
Atsuhiro Nakagawa
1
Department of Neurosurgery, Tohoku University Graduate School of Medicine, Sendai, Japan
2
Department of Biodesign, Clinical Research, Innovation, Education Center, Tohoku University Hospital, Sendai, Japan
,
Toshiki Endo
3
Department of Neurosurgery, Tohoku University, Aoba, Sendai, Japan
4
Department of Neurosurgery, Kohnan Hospital Ringgold Standard Institution, Sendai, Miyagi, Japan
,
Tomohiro Kawaguchi
1
Department of Neurosurgery, Tohoku University Graduate School of Medicine, Sendai, Japan
,
Masato Yamada
5
Division of Advanced Surgical Science and Technology, Tohoku University Graduate School of Medicine Ringgold Standard Institution, Sendai, Miyagi, Japan
,
Chiaki Sato
5
Division of Advanced Surgical Science and Technology, Tohoku University Graduate School of Medicine Ringgold Standard Institution, Sendai, Miyagi, Japan
,
Toshihiro Kumabe
6
Department of Neurosurgery, Kitasato University School of Medicine, Sagamihara, Japan
,
Masaki Iwasaki
7
Department of Neurosurgery, National Center of Neurology and Psychiatry Ringgold Standard Institution, Kodaira, Japan
,
Kuniyasu Niizuma
1
Department of Neurosurgery, Tohoku University Graduate School of Medicine, Sendai, Japan
8
Department of Neurosurgical Engineering and Translational Neuroscience, Tohoku University Graduate School of Biomedical Engineering, Sendai, Japan
9
Department of Neurosurgical Engineering and Translational Neuroscience, Tohoku University Graduate School of Medicine, Sendai, Japan
,
Masayuki Kanamori
1
Department of Neurosurgery, Tohoku University Graduate School of Medicine, Sendai, Japan
,
Chikashi Nakanishi
5
Division of Advanced Surgical Science and Technology, Tohoku University Graduate School of Medicine Ringgold Standard Institution, Sendai, Miyagi, Japan
,
Shinichi Yamashita
10
Department of Urology, Tohoku University Graduate School of Medicine Ringgold Standard Institution, Sendai, Miyagi, Japan
,
Toru Nakano
11
Division of Gastroenterology and Hepatobiliary Pancreatic Surgery, Tohoku Medical and Pharmaceutical University, Sendai, Japan
,
Teiji Tominaga
1
Department of Neurosurgery, Tohoku University Graduate School of Medicine, Sendai, Japan
› Author Affiliations
Funding This work was supported in part by a Grant-in-Aid for Scientific Research (B) (No. 18390388 to TT), Grants-in-Aid for Young Scientists (A) (Nos. 19689030 and 22689039 to AN), and Challenging Exploratory Research (No. 21659313 to AN and No. 25670565 to TN and AN) from the Japanese Ministry of Education, Culture, Sports, Science, and Technology, the Japanese Foundation for Research and Promotion of Endoscopy Grant (to TN and AN), the Tohoku University Exploratory Research Program for Young Scientists (to AN), the Collaborative Research Project of the Institute of Fluid Science, Tohoku University (to AN), and Ogino Award from the Japanese Society for Medical and Biomedical Engineering (to AN).
The piezoelectric ADPJ system was supplied by Seiko Epson Corporation (Suwa, Nagano, Japan). The authors otherwise report no conflict of interest concerning the materials or methods used in this study or the findings specified in this paper.
› Further Information
Also available at
![SFX Search]()
Buy Article Permissions and Reprints
Abstract
Background Pulsed water jet is an emerging surgical instrumentation intended to achieve both maximal lesion resection and functional maintenance through preservation of fine vessels and minimal damage to the surrounding tissue. The piezoelectric actuator-driven pulsed water jet (ADPJ) is a new technology that can deliver a precisely controlled uniform and efficient pulsed water jet with minimum water flow. The present study evaluated the ADPJ system in preclinical animal studies in the swine brain, and investigated breaking strength, one of the parameters for mechanical properties, to elucidate the mechanism of tissue selectivity for tissue dissection by the water jet.
Methods This system consisted of a pump chamber driven by a piezoelectric actuator, a stainless steel tube, and a nozzle (internal diameter: 0.15 mm). Water was supplied at 6 ml/min. The relationship between input voltage (3–25 V at 400 Hz) and peak pressure was measured using a pressure sensor through a sensing hole. The temporal profile of dissection depth during moving application was evaluated using gelatin brain phantom and swine brain. The dissected specimens were evaluated histologically. The mechanical property (breaking strength) of the swine brain was measured by a compact table-top universal tester.
Results Peak pressure increased linearly with increase in input voltage, which reflected the dissection depth in both the gelatin brain phantom and swine brain. Small arteries were preserved, and minimum damage to surrounding tissues occurred. The breaking strength of the arachnoid membrane (0.12 ± 0.014 MPa) was significantly higher compared with the gray matter (0.030 ± 0.010 MPa) and white matter (0.056 ± 0.009 MPa; p < 0.05). The breaking strength of the gray matter corresponded to that of 3 wt% gelatin, and that of white matter corresponded to a value between 3.5 and 4 wt% gelatin, and the dissection depth seemed to be estimated at 3 to 4 wt% gelatin.
Conclusion The present study suggests that the ADPJ system has the potential to achieve accurate tissue dissection with preservation of blood vessels in neurosurgery. The difference in breaking strength may explain the tissue selectivity between the brain parenchyma and tissue protected by the arachnoid membrane.
Keywords
functional preservation -
maximal lesion removal -
minimally invasive surgery -
medical engineering -
water jet
Publication History
Received: 19 June 2022
Accepted: 14 October 2022
Accepted Manuscript online:
17 October 2022
Article published online:
08 November 2024
© 2024. Thieme. All rights reserved.
Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany
References
1
Hirano T,
Komatsu M,
Saeki T.
et al.
Enhancement of fibrinolytics with a laser-induced liquid jet. Lasers Surg Med 2001; 29 (04) 360-368
2
Hirano T,
Nakagawa A,
Uenohara H.
et al.
Pulsed liquid jet dissector using holmium:YAG laser–a novel neurosurgical device for brain incision without impairing vessels. Acta Neurochir (Wien) 2003; 145 (05) 401-406 , discussion 406
3
Hirano T,
Uenohara H,
Komatsu M.
et al.
Holmium:YAG laser-induced liquid jet dissector: a novel prototype device for dissecting organs without impairing vessels. Minim Invasive Neurosurg 2003; 46 (02) 121-125
4
Kawaguchi T,
Nakagawa A,
Endo T,
Fujimura M,
Sonoda Y,
Tominaga T.
Ventricle wall dissection and vascular preservation with the pulsed water jet device: novel tissue dissector for flexible neuroendoscopic surgery. J Neurosurg 2016; 124 (03) 817-822
5
Nakagawa A,
Hirano T,
Komatsu M.
et al.
Holmium: YAG laser-induced liquid jet knife: possible novel method for dissection. Lasers Surg Med 2002; 31 (02) 129-135
6
Nakagawa A,
Hirano T,
Jokura H.
et al.
Pulsed holmium:yttrium-aluminum-garnet laser-induced liquid jet as a novel dissection device in neuroendoscopic surgery. J Neurosurg 2004; 101 (01) 145-150
7
Nakagawa A,
Kumabe T,
Kanamori M.
et al.
Clinical application of pulsed laser-induced liquid jet: preliminary report in glioma surgery [in Japanese]. No Shinkei Geka 2008; 36 (11) 1005-1010
8
Ogawa Y,
Nakagawa A,
Takayama K,
Tominaga T.
Pulsed laser-induced liquid jet for skull base tumor removal with vascular preservation through the transsphenoidal approach: a clinical investigation. Acta Neurochir (Wien) 2011; 153 (04) 823-830
9
Ohki T,
Nakagawa A,
Hirano T.
et al.
Experimental application of pulsed Ho:YAG laser-induced liquid jet as a novel rigid neuroendoscopic dissection device. Lasers Surg Med 2004; 34 (03) 227-234
10
Sato C,
Nakano T,
Nakagawa A.
et al.
Experimental application of pulsed laser-induced water jet for endoscopic submucosal dissection: mechanical investigation and preliminary experiment in swine. Dig Endosc 2013; 25 (03) 255-263
11
Seto T,
Yamamoto H,
Takayama K,
Nakagawa A,
Tominaga T.
Characteristics of an actuator-driven pulsed water jet generator to dissecting soft tissue. Rev Sci Instrum 2011; 82 (05) 055105
12
Tominaga T,
Nakagawa A,
Hirano T.
et al.
Application of underwater shock wave and laser-induced liquid jet to neurosurgery. Shock Waves 2006; 15: 55-67
13
Oertel J,
Gaab MR,
Knapp A,
Essig H,
Warzok R,
Piek J.
Water jet dissection in neurosurgery: experimental results in the porcine cadaveric brain. Neurosurgery 2003; 52 (01) 153-159 , discussion 159
14
Oertel J,
Gaab MR,
Warzok R,
Piek J.
Waterjet dissection in the brain: review of the experimental and clinical data with special reference to meningioma surgery. Neurosurg Rev 2003; 26 (03) 168-174
15
Oertel J,
Gaab MR,
Pillich DT,
Schroeder HW,
Warzok R,
Piek J.
Comparison of waterjet dissection and ultrasonic aspiration: an in vivo study in the rabbit brain. J Neurosurg 2004; 100 (03) 498-504
16
Oertel J,
Gen M,
Krauss JK,
Zumkeller M,
Gaab MR.
The use of waterjet dissection in endoscopic neurosurgery. Technical note. J Neurosurg 2006; 105 (06) 928-931
17
Papachristou DN,
Barters R.
Resection of the liver with a water jet. Br J Surg 1982; 69 (02) 93-94
18
Piek J,
Wille C,
Warzok R,
Gaab MR.
Waterjet dissection of the brain: experimental and first clinical results. Technical note. J Neurosurg 1998; 89 (05) 861-864
19
Rau HG,
Duessel AP,
Wurzbacher S.
The use of water-jet dissection in open and laparoscopic liver resection. HPB (Oxford) 2008; 10 (04) 275-280
20
Terzis AJ,
Nowak G,
Rentzsch O,
Arnold H,
Diebold J,
Baretton G.
A new system for cutting brain tissue preserving vessels: water jet cutting. Br J Neurosurg 1989; 3 (03) 361-366
21
Tschan C,
Gaab MR,
Krauss JK,
Oertel J.
Waterjet dissection of the vestibulocochlear nerve: an experimental study. J Neurosurg 2009; 110 (04) 656-661
22
Tschan CA,
Tschan K,
Krauss JK,
Oertel J.
First experimental results with a new waterjet dissector: Erbejet 2. Acta Neurochir (Wien) 2009; 151 (11) 1473-1482
23
Elkin BS,
Ilankovan AI,
Morrison III B.
A detailed viscoelastic characterization of the P17 and adult rat brain. J Neurotrauma 2011; 28 (11) 2235-2244
24
Walsh EK,
Schettini A.
Elastic behavior of brain tissue in vivo. Am J Physiol 1976; 230 (04) 1058-1062
25
Walsh EK,
Schettini A.
Calculation of brain elastic parameters in vivo. Am J Physiol 1984; 247 (4, Pt 2): R693-R700
26
Aoyagi N,
Masuzawa H,
Sano K.
Compliance of the brain (author's transl) [in Japanese]. No To Shinkei 1980; 32 (01) 47-56
27
Galford JE,
McElhaney JH.
A viscoelastic study of scalp, brain, and dura. J Biomech 1970; 3 (02) 211-221
28
Nagashima T,
Shirakuni T,
Rapoport SI.
A two-dimensional, finite element analysis of vasogenic brain edema. Neurol Med Chir (Tokyo) 1990; 30 (01) 1-9
29
Takizawa H,
Sugiura K,
Baba M.
et al.
Stress distribution in the brain: numerical simulation by the finite element method [in Japanese]. No To Shinkei 1987; 39 (12) 1125-1129
30
Takizawa H,
Sugiura K,
Baba M,
Miller JD.
Analysis of intracerebral hematoma shapes by numerical computer simulation using the finite element method. Neurol Med Chir (Tokyo) 1994; 34 (02) 65-69
31
Seki S,
Iwamoto H.
Disruptive forces for swine heart, liver, and spleen: their breaking stresses. J Trauma 1998; 45 (06) 1079-1083
32
Okitani A,
Oneda Y,
Kubo T.
et al.
Softening mechanism of vacuum-cooked squid muscle [in Japanese]. Nippon Shokuhin Kagaku Kogaku Kaishi 2008; 55: 170-176
33
Aimedieu P,
Grebe R.
Tensile strength of cranial pia mater: preliminary results. J Neurosurg 2004; 100 (01) 111-114
34
Krag S,
Olsen T,
Andreassen TT.
Biomechanical characteristics of the human anterior lens capsule in relation to age. Invest Ophthalmol Vis Sci 1997; 38 (02) 357-363
35
Killory BD,
Chang SW,
Wait SD,
Spetzler RF.
Use of flexible hollow-core CO2 laser in microsurgical resection of CNS lesions: early surgical experience. Neurosurgery 2010; 66 (06) 1187-1192
36
Passacantilli E,
Antonelli M,
D'Amico A.
et al.
Neurosurgical applications of the 2-μm thulium laser: histological evaluation of meningiomas in comparison to bipolar forceps and an ultrasonic aspirator. Photomed Laser Surg 2012; 30 (05) 286-292
37
Carrabba G,
Mandonnet E,
Fava E.
et al.
Transient inhibition of motor function induced by the Cavitron ultrasonic surgical aspirator during brain mapping. Neurosurgery 2008; 63 (01) E178-E179 , discussion E179
38
Ridderheim PA,
von Essen C,
Zetterlund B.
Indirect injury to cranial nerves after surgery with Cavitron ultrasonic surgical aspirator (CUSA). Case report. Acta Neurochir (Wien) 1987; 89 (1–2): 84-86
39
Turner RJ,
Cohen RA,
Voet RL,
Stephens SR,
Weinstein SA.
Analysis of tissue margins of cone biopsy specimens obtained with “cold knife,” CO2 and Nd:YAG lasers and a radiofrequency surgical unit. J Reprod Med 1992; 37 (07) 607-610
40
Kroh M,
Hall R,
Udomsawaengsup S,
Smith A,
Yerian L,
Chand B.
Endoscopic water jets used to ablate Barrett's esophagus: preliminary results of a new technique. Surg Endosc 2008; 22 (11) 2498-2502
41
Gasiński M,
Modrzejewski M,
Cenda P,
Nazim-Zygadło E,
Kozok A,
Dobosz P.
Application of water jet ERBEJET 2 in salivary glands surgery [in Polish]. Otolaryngol Pol 2009; 63 (07) 47-49
42
Aroussi AA,
Sami IM,
Leguerrier A,
Verhoye JP.
The blower: a useful tool to complete thrombectomy of the mechanical prosthetic valve. Ann Thorac Surg 2006; 81 (05) 1911-1912
43
Miller JM,
Palanker DV,
Vankov A,
Marmor MF,
Blumenkranz MS.
Precision and safety of the pulsed electron avalanche knife in vitreoretinal surgery. Arch Ophthalmol 2003; 121 (06) 871-877
留言 (0)