Pressurized hydrodissection for CT-guided percutaneous peritoneal navigation: The hydro jet technique.

The purpose of this paper is to evaluate the effectiveness of a new technique of hydrodissection for peritoneal structures displacement during preoperative localization markers placement. We retrospectively reviewed two cases of percutaneous fiducial marker placement prior rescue retroperitoneal lymphadenectomy. In both cases pressurized 5% dextrose in water (D5W) was used to hydrodissect the peritoneal space and securely reach the lymph nodes. Two patients were submitted to water jet technique for transperitoneal trespassing to reach the retroperitoneum. The volume of fluid used to navigate was 125-200 mL and the mean time to cross the peritoneum was 6 min 47 s (ranging from 3″26' to 10″24'). In conclusion, Bowel and small vessels displacement using pressurized D5W is a safe method to reach retroperitoneal space during percutaneous procedures.