Hepatic parenchymal resection with waterjet in the malignant setting – Results of an Initial Foray

Background: Liver resections for malignant disease are often complicated by significant intraoperative bleeding due to the liver’s rich vascularity. The waterjet device offers a tissue-selective dissection technique aimed at reducing blood loss and preserve vital intrahepatic structures. This study evaluates the efficacy and safety of hydrodissection in liver resections performed for malignant indications. Methods: This retrospective analysis included 27 patients who underwent hepatic resections using the ERBE® waterjet device between April 2023 and June 2024 at a tertiary oncology center in North East India. Procedures included radical cholecystectomy (n = 16), metastasectomy (n = 7), left lateral sectionectomy (n = 2), right anterior sectionectomy (n = 1), and wedge resection (n = 1). Intraoperative parameters (blood loss, duration, need for inflow occlusion) and postoperative outcomes (bile leak, transaminase elevation, transfusion requirement) were assessed. Results: Median transection time was 36 min (range: 20–150), with a median blood loss of 150 mL (range: 80–350). Only one patient (3.7%) required the Pringle maneuver. Bile leak occurred in two patients (7.4%), resolving without intervention. Postoperative transaminase elevation (>3× ULN) was observed in 9 patients (33.3%), and 15 patients (59.3%) required blood transfusions. Median hospital stay was 4 days (range: 2–8). No reoperations or 30-day readmissions occurred. Conclusions: Waterjet-assisted liver resection appears to be a safe and hemostatically effective technique in malignant hepatic surgery, especially in limited resections. It minimizes blood loss, reduces reliance on vascular inflow occlusion, and preserves key vascular and biliary structures. These findings support the utility of hydrodissection in oncological liver surgery, warranting further prospective studies for broader validation.