Tehnologija abrazivnog vodenog mlaza od nedavno se koristi uglavnom u industrijskim područjima. Ova tehnologija pruža nekoliko prednosti u usporedbi s konvencionalnim metodama. Trenutačno, to je uporaba u medicini. U radu se razmatra mogućnost korištenja tehnologije mlaza vode u medicini. U radu su opisane prednosti i uporaba u ortopedskoj kirurgiji, plastičnoj kirurgiji, neurokirurgiji, dermatologiji, urologiji te u oralnoj kirurgiji.Abrasive water jet technology has been recently used mainly in industrial areas. This technology provides several advantages in comparison with conventional methods. At present, it is used in medicine. This paper discusses the possibility of using water jet technology in medicine. The paper describes the benefits and usage in orthopedic surgery, plastic surgery, neurosurgery, dermatology, urology, and in dental surgery

Dagmar Magurová

Dražan Kozak

Jan Valíček

Marko Rakin

Marta Harničárová

Pavol Hreha

Sergej Hloch

Tehnicki vjesnik - Technical Gazette

Hrčak - Portal of scientific journals of Croatia

1Introduction2State of the artUvodPrikaz stanjaRapidly expanding industry, along with its increasingrequirements for production quality, demands continualimplementation of technologies that meet demandingcriteria given by market environment and its requirements[12, 13, 14, 15]. Today, the production technologistsencounter the need to adapt the existing technologies for thespecific properties of new materials or for developing newones. The water jet is one of the few instruments able to copewith the technologists' requirements and to adapt to thetrend of development of engineering materials with specificproperties. Water jet cutting is currently characterized as analternative method of cutting sheet materials. The principleof hydroabrasive cutting consists in bloominghydroabrasive stream where only water, divided by thematerial leading to it, is disintegrated. The impact ofmixture on divided material causes its cut. Permeate, whichis the carrier of kinetic energy abrasive, drains the removalproducts from the kerf and provides cooling kerf. That isprecisely the space cooling section that gives an advantageto the technology division over conventional materialstechnology division which involves adding of unwantedheat to shared materials with subsequent change in thestructure, deformation, and change in visual appearance.The abrasive water jet technology is currently used forcutting a wide range of materials. The main advantages ofthis technology include the lack of thermal effect onmachined material. Water jet is applied to all kinds ofindustries. However, possibilities of its further usage havenot been exhausted yet. Medicine is a field where thistechnology is used very little.Water jet cutting device consists of a pump whichserves for creating a working fluid pressure of cutting2 73P  Hreha, S  Hloch, D  Magurová, D  Kozak, M  Rakin. . . J. Valíček, . M. Harničárová, .ISSN 1330-3651UDC/UDK 621.924.93:616WATER JET TECHNOLOGY USED IN MEDICINEPavol Hreha, Sergej Hloch, Dagmar Magurová, ,Dražan Kozak, , Marko RakinJan ValíčekMarta HarničárováAbrasive water jet technology has been recently used mainly in industrial areas. This technology provides several advantages in comparison with conventionalmethods. At present, it is used in medicine. This paper discusses the possibility of using water jet technology in medicine. The paper describes the benefits andusage in orthopedic surgery, plastic surgery, neurosurgery, dermatology, urology, and in dental surgery.Keywords: abrasive water jet, medicineSubject reviewTehnologija abrazivnog vodenog mlaza od nedavno se iuporaba mlaza vode u medicini. U radu suopisane prednosti i uporaba i, dermatologiji, urologiji te u oralnoj kirurgiji.koristi uglavnom u industrijskim područjima. Ova tehnologija pruža nekoliko prednosti u usporedb skonvencionalnim metodama. Trenutačno, to je u medicini. U radu se razmatra mogućnost korištenja tehnologijeu ortopedskoj kirurgiji, plastičnoj kirurgiji, neurokirurgijKljučne riječi: abrazivni vodeni mlaz, medicinaPregledni članakTehnologija vodenog mlaza koja se koristi u mediciniTehnologija vodenog mlaza koja se koristi u mediciniTechnical Gazette 17, (2010),2 2 7-2403fluid (in medicine it is a sterile saline – 0,9 % aqueoussolution of sodium chloride-NaCl), the cutting headforming a fluid flow and a mixing chamber in which theabrasive is added into the fluid. Fig. 1 shows thetechnological scheme of AWJ (Abrasive Water Jet) place ofwork. The cutting high pressure water has been used inindustry for a long time. Lately, this technology has alsofound its application in medical field such as: trombektomy,artoscopic backbone operations, as well as in plastic surgeryfor removal of tattoos or liposuction for endoscopy andsurgical ophthalmology. Papachristou and Barters [8] werethe first who described the usage of water stream inmedicine. Four patients had a liver resection throughphysiologically saline. They came to the conclusion that theusage of the water jet led to the reduction of blood lossduring the surgery.Figure1Slika 1.Scheme of AWJ technology groupShema tehnološke grupe abrazivnog mlaza vode3Water jet used in clinical conditionsVodeni mlaz koji se koristi u kliničkim uvjetimaThe first medical use was in 1980, when this kind oftechnology was used for cutting bodies and endoprothesis2 83Water jet technology used in medicineTehni ki vjesnikč ,17, 2(2010)  2 7-2403[5]. Since there is no heat which affects the cut materialduring the abrasive water jet cutting, this technology issuitable for applications where the structural change ofmaterial is not permitted. The critical temperature is muchlower for medical applications than for industrial usage.Biscup [1] dealt with this issue at using the abrasive waterjet cutting bone. Bones are very sensitive to heat. Damage oftissue depends on temperature and time of exposure. Thedamage is irreversible even after 10 seconds at 57 ° whenthere is necrosis and poor healing of a bone. Pude [6] dealt inhis work with the appropriate abrasive at kneeendoprosthese surgery. As abrasive, the soluble substancesare used during this surgery which ensures better removal ofabrasives from the operated area. Sugar proved to be asuitable material. Pude et al. (2003) [6] dealt with theinvestigation of these substances: sucrose, xyilitol, lactose,sorbitol. Sorbitol reached the highest value regarding thedepth of cut achieved. Fig. 2 shows comparison of theresults. In addition, dividing bone liquid stream is dealt withby Schwieger et al. [18].CP  Hreha, S  Hloch, D  Magurová, D  Kozak, M  Rakin. . . J. Valíček, . M. Harničárová, .dental surgery. Using this technology brings the followingbenefits:- no generation of heat, sound or pressure,- reduces the need for anesthesia,- gives much more healthy dental tissues,- leaves a relatively dry work area, which is an advantagefor the subsequent hole filling,- reduces the risk of micro-cleavage and jagged teeth.Ciancio [17] deals with the use of AWJ in dentalsurgery.Fig. 3 shows an operating device for a knee jointreplacement surgery with the assistance of hydroabrasivejet. Fig. 4 shows a bone cut by the water jet.Figure 2Slika 2.Dependence of depth of cut and type of abrasivesOvisnost dubine reza i vrste abraziva[6][6]Figure 3Slika 3.Operating device (A); detailed cassette with abrasive (B) [6][6]Operacijski uređaj (A); detalj kasete s abrazivom (B)Figure 4Slika 4.Division of a bone by the water jetRezanje kosti vodenim mlazom[6][6]Dental surgery is another medical area [2, 4] where thecutting and grinding of dental materials is used withAWJ. Inaddition to water jet, the so called air grinding with the waterjet assistance is used. Fig. 6 shows the head of device used inFigure 5Slika 5.Liver resection through the water jetResekcija jetre vodenim mlazomFigure 6Slika 6.Air grinding with the water jet [2][2]Glava uređaja za brušenje vodenim mlazomThe water jet is applied also at cleaning of traumaticwounds. The healing process of these wounds has beencodified with the abbreviation "TINE". Tissue necrosis (T)indicates dead tissue. The entire dead and damaged tissue,including the lack of blood supply, must be removed. Mark(I) denotes infection. Bacterial burden must not be greaterthan 100 000 bacteria/g. Moisture balance (M) indicates thebalance of moisture for the best healing of wounds. Edge (E)indicates the wound edge, which must be protected. Usingof the water jet as a scalpel resulted in more healthy tissuethan using the conventional methods. This technology(versajet) also allows good cleaning of wounds from foreignelements (earth, sand, silicone gel from the implants), whichwould otherwise be incorporated into the healing of the skinand it would create a traumatic tattoo. It is a useful tool fordegreasing of skin grafts. Another field where the water jetcan be used is liposuction. Water Jet Liposuction (WJL) is.2 93Technical Gazette ,17, 2(2010)  2 7-2403Tehnologija vodenog mlaza koja se koristi u mediciniP  Hreha, S  Hloch, D  Magurová, D  Kozak, M  Rakin. . . J. Valíček, . M. Harničárová, .non-edema method which maximizes the benefits of the oldmethods. WAL (Waterjet Assisted Liposuction) uses a thinfan-shaped stream by which it releases fat cells while savingblood vessels and nerves. Fat cells are removed and driftedout by saline. Benefits of WALare as follows:- results can be achieved with greater accuracy, withoutedema and contour changes,- better mobility of patients, optimized access to thetreated area,- greater comfort of the patient and postoperative woundinfiltration is less than 24 hours,- number of medications for patients is reduced and theresidual volumes are kept at minimal level.Further, the hydroabrasive jet is used in dermatologyfor dead skin removing. Water flow is dosed with variousdrugs, such as anesthetics, for the elimination or reductionof pain, antiseptics to disinfect violation of the skinintegrity, or medications coagulation preparations for bettercoagulation of blood.Microwave Waterjet scalpel is another application ofthe water flow in medicine. It is used for minimally invasiveremoval or resection of tumors. It is a combination of amicrowave scalpel and a jet system. It allows control of aflow directly into the saline, directly into the workspace.Then it reduces the risk caused by heat from the microwaveradiation. The direct usage of the water jet scalpel in surgeryhas brought several advantages compared to other methods.It uses sensitive pressure of sterile saline in order to resecttissue. The applicator consists of a nozzle jet with a diameterof 120 micrometers. The sensitivity of saline jet may vary independence on the type of shared tissue (nerve tissue,ligaments, blood vessels, etc.). Fig. 7 depicts applicators ofERBEJET 2 used in surgery.time was shorter with the water jet (28 ± 11 min) incomparison with CUSA(46 ± 19 min). Duration of ischemywas also markedly reduced [10]. Liver resection is shown inFig. 5. The operation can be performed in a laparoscopicway or by an open method. While using the water jettechnology at the cholecystectomy, there was a gallbladderperforation in the amount of 15 % of cases, whereas whileusing the traditional methods, it was 30 %. There was lessdamage of neighboring tissue at the open operations ofpatients who were diagnosed with kidney tumor or withkidney stones in vacuolization from 100 to 300 micrometerscomparing to thermal methods (laser, electric cautery). Theoperation by the water jet lasted from 14 up to 35 minutesand an average blood loss was 60 ml [9]. In urology, thewater jet resection reduces the risk of sexual dysfunction[16]. Neural connections and blood vessels remain almostuntouched during prostatectomy. In neurosurgery, this tooldoes not leave any necrosis along the edges of the cut. It isapplied to elimination of metastases and glioma. Tumorresection is performed selectively, without traumatizing ofthe healthy brain parenchyma, while saving the brainstructure. Oertel et al. [11] describes the experience withbrain metastases resection with the water jet. Water flow is aparticularly useful tool while separating the soft poorlydemarcated brain metastases from the surrounding brainparenchyma. The removal of these metastases is verydifficult by conventional methods [11]. The following Table1 shows an overview of using water jet in medicine.Figure 7Slika 7.Applicators of system ERBEJET 2Aplikatori sustava ERBEJET 2Figure 8Slika 8.Body-Jet Water-Jet Assisted Liposuction applicatorAplikatori sustava ERBEJET 20This system is used in surgery, for example at liverresection [7], blood vessels and biliary channels. During thecut, these are cleaned of neighboring tissues and they can betreated individually. The necessary time for this kind ofoperation by this method is significantly reduced and alsoblood loss is limited. A continuous flow of saline provides aclear operating field for the surgeon. Rau et al. [1  ]describes the comparison of results of liver surgery with 61patients. 31 patients were operated through the water jet and30 patients were operated through the CUSA. The resectionTable 1Tablica 1.Overview of using water jet in medicinePregled uporabe vodenog mlaza u medicini4ConclusionZaključakThe operating parameters for surgical applications arevery different from industrial applications. Sterility ofworking fluid is the most important requirement inmedicine. This problem is managed by using a special bagwith a sterile cutting fluid. In medicine, water jet has severalArea Use BenefitsOrthopedicsCutting endoprostheseand boneBelow the criticaltemperature by cuttingDental surgeryCutting and grinding ofdental materialsReduces the risk ofjagged teeth andreduces the need foranesthesiaSurgeryResection of softtissues: liver, gallbladder, brain, kidney,prostate, cleaningwoundsBlood vessels andnerve fibers remain inthe defined pressuremaintained, minimalbleeding, intact edgesand precise cuts, lackof necrotic edge,reduce the duration ofmyocardial ischemiaPlastic SurgeryCleaning skin graft,removal of tattoos,liposuctionSeparation of thelayers of tissue, higheraccuracy of resultswithout edema andcontour changesDermatology Removing dead skinPossibility of directdose medications in awater jet240 Tehni ki vjesnikč ,17, 2(2010)  2 7-2403P  Hreha, S  Hloch, D  Magurová, D  Kozak, M  Rakin. . . J. Valíček, . M. Harničárová, .Water jet technology used in medicinebenefits compared to the traditional methods. It reachesonly a low temperature during cutting and therefore it doesnot damage surrounding tissue. Depth of cut can becontrolled by fluid pressure; it enables high-precisioncutting, provides a constant cutting force in changing thedistance, leaves a clean cut as it immediately flushes out thetissue separated from the cut, reduces bleeding at surgery,shortens the duration of ischemy, shortens the time ofhospitalization; operations can be made even inlaparoscopic way.The paper was prepared with theprojectASCR No.AV0Z30860518.Acknowledgements:5ReferencesReference[1] Biskup, C.; Hover, M.; Versemann, R.; Bach, F.-W.; Kromer,S.; Kirsch, L.; Andreae, A.; Pude, F.; Schmolke, S. HeatGeneration During Abrasive Water-Jet OsteotomiesMeasured by Thermocouples. In: STROJNISKI VESTNIK.52, 7/8 (2006), pp. 451 457[2] Takasawa Yoshiaki. Water jet technology for medicine andbiology. In: Journal of the Japan Society for AbrasiveTechnology (JSAT). 50, 5 (2006), pp 257 260[3] Baer, H. U.; Maddern, G. J.; Dennison, A.R.; Blumgart, L. H.Water-jet dissection in hepatic surgery. In: Minim InvasiveTher. 4, 1 (1992), pp. 169-172[4] Tegtmeyer, S.; Biskup, C.; Borchers, L.; Bach, F-W.; Stiesch-Scholz, M. Abrasive water jet drilling of human dentine, In:IADR[5] Honl, M.; Rentzsch, R.; Lampe, F.; Müller, V.; Dierk, O.;Hille, E.; Louis, H.; Morlock, M. Water jet cutting of bone andbone cement. A study of the possibilities and limitations of anew technique. In: Biomedizinische Technik. 45 (2000), pp222 227[6] Pude, F.; Schmolke, St.; Kirsch, L.; Schwieger, K.; Honl, M.;Louis, H. Abrasive Waterjets as a New Tool for Cutting ofBone - Laboratory Tests in the Field of Knee Endoprosthese.In: MIT'2003 ISBN 961-6238-81-7[7] Richter, S.; Kollmar, O.; Schuld, J.; Moussavian, M. R.; Igna,D.; Schilling, M. K. For the Chirurgische ArbegemeinschaftIO-Technik und O-Strukturen (CAOP) of the DeutscheGesellschaft für Allgemein – und Viszeralchirurgie:Randomized clinical trial of efficacy and costs of threedissection devices in liver resection. In: British Journal ofSurgery. 96, 10 (2009)[8] Papachristou, D. N.; Barters, R. Resection of the liver with awater jet. In: British Journal of Surgery. 69, 2 (1982), pp. 9394[9] Basting, R. F.; Djakovic, N.; Widmann, P. Use of water jetresection in organ-sparing kidney surgery. In: Journal ofEndourology. 14, 6 (2000), pp. 501 505[10] Rau, H. G.; Wichmann, M. W.; Schinkel, S.; Buttler, E.;Pickelmann, S.; Schauer, R. et al. Surgical techniques inhepatic resections: Ultrasonic aspirator versus Jet-Cutter. Aprospective randomized clinical Trial. In: Zentralbl Chir. 126,6 (2001), pp. 586 590[11] Ortel, J.; Gaab, M. R.; Piek, J. Water jet resection of brainmetastases - first clinical results with 10 patients. In: Eur JSurg Oncol. 29, 4 (2003), pp. 407 414[12] Botak, Z.; Kondic, Z.; Maderic, D. WaterJet Machining. In:Technical Gazette, 16 (2009), pp. 97-101[13] Hloch, S. et al. Experimental study of surface topographycreated by abrasive water jet cutting. In: Strojarstvo. 49, 4(2008), pp. 303-309.[14] Radvanska, A. Abrasive water jet cutting technology riskassessment by means of failure modes and effects analysismethod. In. Tehnicki Vjesnik-Technical Gazette. 17, 1(2010), pp. 121-128- .- ..- ...-.- .- .- ., 3 ..[15] Valicek, J. Hloch, S. Kozak, D. Surface geometricparameters proposal for the advanced control of abrasivewaterjet technology. In. International Journal of AdvancedManufacturing Technology. 41, 3-4 (2009), pp. 323-328.[16] Shekarriz, B. Hydro-Jet technology in urologic surgery, In:Expert Rev Med Devices, 2, 3 (2005), pp. 287- 91[17] Ciancio, S G. The dental water jet: a product ahead of its time,In: Compend Contin Educ Dent, 1 (2009), pp 7-13[18] Schwieger, K. Carrero, V. Rentzsch, R. Becker, A. Bishop,N. Hille, E. Morlock, M. Honl, M. Abrasive water jetcutting as a new procedure for cuttungcancellous bone-invitro testing in comparison with the oscillating saw, In: JBiomed Mater Res B Apple Biomater, 71, 2 (2004), pp. 223-8; ;2 ...; ; ; ;; ; ;22 .Authors' addressesAdrese autoraPavol HrehaSergej HlochDagmar MagurováDražan KozakMarko RakinFaculty of Manufacturing Technologiesof Technical University of Košice with a seat in PrešovBayerova 1, 080 01 PrešovSlovak RepublicFaculty of Manufacturing Technologiesof Technical University of Košice with a seat in PrešovBayerova 1, 080 01 PrešovSlovak RepublicFaculty of Health, Prešov UniversityUl. Partizanska 1, 080 01 PrešovSlovak RepublicInstitute of Geonics of the ASCR, v. v. i.Studentska 1768, 708 00 Ostrava – PorubaCzech RepublicMechanical Engineering Faculty in Slavonski BrodJ. J. Strossmayer University of OsijekTrg Ivane BRepublic of CroatiaFaculty of Manufacturing Technologiesof Technical University of Košice with a seat in PrešovBayerova 1, 080 01 PrešovSlovak RepublicFaculty of Technology and MetallurgyUniversity of BelgradeKarnegijeva 4, RS-11120 BelgradeRepublic of Serbiarlić-Mažuranić 2, HR-35000 Slavonski BrodJan ValíčekMarta Harničárová

Water jet technology used in medicine

Abrasive water jet technology has been recently used mainly in industrial areas. This technology provides several advantages in comparison with conventional methods. At present, it is used in medicine. This paper discusses the possibility of using water jet technology in medicine. The paper describes the benefits and usage in orthopedic surgery, plastic surgery, neurosurgery, dermatology, urology, and in dental surgery

Water jet technology used in medicine

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