Water Veil Effect to Control Splashing from the Pulsed Water Jet Device: Minimizing the Potential Risk of Dissemination Using Surgical Aspirators.

Abstract

Maximum resection with minimum damage to normal structures is required for a better clinical outcome. Several efficient surgical devices such as the Cavitron ultrasonic surgical aspirator are available. Our group developed the actuator-driven pulsed water jet (ADPJ) to dissect soft tissue with vessel preservation. Although these devices are very effective for resection, tumor seeding is a potential risk. The present study investigated the control of splashing during ADPJ use. We demonstrate the effect of additional water flow around the instrument tip to veil the splashing. Pulsed water jet was ejected from the tip of the ADPJ nozzle. Effects of ADPJ parameters such as input voltage, suction pressure, and distance between the nozzle and the target (standoff distance) on the amount of splashing were analyzed. Methylene blue solution was ejected on photo paper, gelatin brain phantom, and porcine brain harvested and subsequently immersed into physiologic saline to quantify the amount of splashing. High-input voltage and a long standoff distance had significant correlations with large amounts of splashing (r > 0.5; p < 0.01). However, suction pressure had no correlation (r = 0.23). Additional water flow combined with the ADPJ decreased the amount of splashing. A high-speed camera recording revealed that the additional water flow formed a water veil that prevented droplet dispersion, as confirmed with experiments using the brain phantom and porcine brain, in which the irregularity and elasticity are specific. The veil effect of additional water flow is important to reduce splashing during ADPJ use and can minimize the potential risk of dissemination and enhance the safety of the ADPJ.