In waterjet surgery a thin and high pressure waterjet is used to prepare soft tissue. This method was first presented in the British Journal of Surgery by Papachristou and Bartes as "Resection of the liver with a waterjet" in 1982.
There, the selective aspect which is the main advantage of the waterjet method is introduced. Soft tissue as e.g. parenchyma is washed away whereas structures with a higher mechanical resistance against the waterjet impact like nerves and vessels remain intact. This leads to less interoperative loss of blood and less parenchymal trauma. These effects have also been acknowledged by various other publications.
Another advantage of the method is that the cell structures at the borders of the cut stay intact since there is no thermal damage.
In open surgery preparing soft tissue by waterjet is a repetitive process as only few cell layers are washed away when moving the waterjet over the tissue. This results in the requirement that the waterjet has to be moved continually during the preparation process. The movement is quite easy to perform in open surgery but is very difficult in minimally invasive interventions due to the kinematic restriction given by the trocar.
By use of robotics these restrictions can be overcome and the waterjet method can be used in the same manner as in open surgery. Therefore the waterjet is no longer limited to a few minimally invasive cases but can be used in several minimally invasive interventions.
T. Bahls, F. A. Fröhlich, A. Hellings, B. Deutschmann and A. O. Albu-Schäffer, "Extending the Capability of Using a Waterjet in Surgical Interventions by the Use of Robotics" in IEEE Transactions on Biomedical Engineering , vol.PP, no.99, pp.1-1, doi: 10.1109/TBME.2016.2553720
T.Bahls, F.A. Fröhlich and A. O. Albu-Schäffer, "Towards Robot Guided Waterjet Surgery" in 12. Jahrestagung der Deutschen Gesellschaft für Computer- und Roboterassistierte Chirurgie (CURAC), Innsbruck, Austria, November 2013. elib