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The art of the competent surgeon: Anatomy and surgical dissection
Published in Resad Paya Pasic, Andrew I. Brill, Practical Manual of Minimally Invasive Gynecologic and Robotic Surgery, 2017
Hydrodissection is the pressurized delivery of sterile fluid into the surgical field in order to tent and thin out the underlying connective tissue fibers (Figure 2.3). By grasping and tenting the peritoneum or tissue to be incised, the operator elevates the tissue away from the vital structures lying underneath—ureter, artery, vein, bowel, bladder, and somatic nerve. Grasping and tenting of the tissues also thins out and stretches the grasped tissue so that the edge of the bowel or a large blood vessel can be better seen. A mm incision can be safely made without concern for injury to underlying structures. With the gentle push-spread (“poke and open”) technique, the operator further thins out the embedding connective tissues and fibrosis to further reveal what structures lie therein. This step is further aided by gentle traction and countertraction, and tenting before further cutting or gentle wiping proceeds. These maneuvers are repeated millimeter by millimeter and over and over until the tissues are completely thinned, revealing the vital anatomic structures in that anatomic region. Always stay parallel to vital structures when performing blunt traction and countertraction for tissue exposure.
Pars plana lensectomy
Published in A Peyman MD Gholam, A Meffert MD Stephen, D Conway MD FACS Mandi, Chiasson Trisha, Vitreoretinal Surgical Techniques, 2019
Andrew W Eller, Brian B Berger
Hydrodissection has become an important part of modern cataract surgery, because it separates the nucleus from the lens capsule and allows it to be mobilized.23 This is a useful technique, because the nucleus can be manipulated without putting stress on the lens capsule or zonules, thereby reducing the risk of a rupture. Preservation of the posterior capsule eliminates the potential problem of lens fragments drifting to the posterior pole.
Image-based computer modeling assessment of microwave ablation for treatment of adrenal tumors
Published in International Journal of Hyperthermia, 2022
Jan Sebek, Grazia Cappiello, George Rahmani, Nooshin Zeinali, Muireann Keating, Michael Fayemiwo, Jim Harkin, Liam McDaid, Bryan Gardiner, Declan Sheppard, Russell Senanayake, Mark Gurnell, Martin O’Halloran, M. Conall Dennedy, Punit Prakash
In this computational modeling study, 8/14 simulated ablations were terminated due to thermal damage to surrounding non-target structures exceeding pre-defined tolerable thresholds. In clinical practice, structures around the ablation target can be displaced by the injection of gas/liquid as a thermoprotective measure. Hydrodissection, which involves the infusion of fluid between the target tissue and adjacent structures is a common technique used to protect adjacent structures from thermal damage [53]. This fluid becomes a physical barrier between the target zone of ablation and neighboring tissue. Our models did not include the effect of hydrodissection on structure location when estimating organ thermal exposure damage. Incorporating hydrodisscetion in computational models of ablation is technically challenging, as the extent of displacement is often operator- and patient-specific, with the volume and rate of infusion of the liquid impacting the barrier size and duration.