Evaluation of a newly developed piezo actuator-driven pulsed water jet system for liver resection in a surviving swine animal model

Background: Preservation of the hepatic vessels while dividing the parenchyma is key to achieving safe liver resection in a timely manner. In this study, we assessed the feasibility of a newly developed, piezo actuator-driven pulsed water jet (ADPJ) for liver resection in a surviving swine model. Methods: Ten domestic pigs underwent liver resection. Parenchymal transection and vessel skeletonization were performed using the ADPJ (group A, n=5) or an ultrasonic aspirator (group U, n=5). The water jet was applied at a frequency of 400Hz and a driving voltage of 80V. Physiological saline was supplied at a flow rate of 7ml/min. After 7days, the animals were killed and their short-term complications were examined and compared between the two groups. Results: No significant complications, such as massive bleeding, occurred in either group during the surgical procedures. The transection time per transection area was significantly shorter in group A than in group U (1.5±0.3 vs. 2.3±0.5min/cm², respectively, P=0.03). Blood loss per transection area was not significantly different between groups A and U (9.3±4.2 vs. 11.7±2.3ml/cm², P=0.6). All pigs in group A survived for 7days. No postoperative bleeding or bile leakage was observed in any animal at necropsy. Conclusion: The present results suggested that the ADPJ reduces transection time without increasing blood loss. ADPJ is a safe and feasible device for liver parenchymal transection.