The use of water jet dissection in surgery for renal tumors in children

Abstract

   The search for a more advanced and effective method of tissue separation is continuously ongoing. In present-day surgery, the key to a successful extensive resection of a parenchymal organ is the use of a wide array of medical devices such as modern generators, surgical instruments, and anesthetic equipment. In this regard, water-jet dissectors as a tool for resection of parenchymal organs can take their place in the list of equipment used in pediatric surgery and pediatric oncology in particular, and contribute to improving patient outcomes. Here we present our experience of using water jet dissection in surgery for renal tumors in children. The work is based on the analysis of clinical material of 48 children with kidney tumors. The study was approved by an Independent Ethics Committee and the Scientific Council of the V.F. Voyno-Yasenetsky Scientific and Practical Center of Specialized Medical Care for Children. All diagnoses were confirmed by histological examination. All patients were divided into two groups: the experimental group (n = 19) and the control group (n = 29). In the experimental group (n = 19), the water jet dissection method was employed, while the children in the control group (n = 29) were operated on using standard techniques. The average duration of the surgery was 200 ± 51 minutes in the experimental group and 198 ± 92 minutes in the control group (p = 0.5). The total volume of intraoperative blood loss differed significantly between the groups: 137.3 ± 101 ml in the experimental group, and 268.1 ± 217.5 mL in the controls (p = 0.05). The patients from the experimental group stayed at the intensive care unit for a shorter period of time: 2.2 ± 0.8 days, compared to 3.5 ± 1.0 days (p = 0.04) in the control group. What is more, the children from the experimental group did not develop any complications after the surgery, while in the control group, complications were registered in 17.1 % of patients. The use of water jet surgery for resection led to reduced blood loss during parenchymal transection. The most important result of the use of water jet dissection was a significant reduction in the frequency of intraoperative blood loss, duration of surgery, and postoperative complications (from 17.1 to 0 %).