MINIMALLY INVASIVE ENDOSCOPIC GRAFT HARVESTING PROCEDURE WITH RE-USABLE DEVICES
Toshimi UJIIE, Hisato Ito.
Shi-Yurigaoka General Hospital, Kawasaki city, Kanagawa, Japan.
OBJECTIVE: We improve the less invasive graft harvesting ( SVG & radial artery) procedure with the endoscopic device and the ultra sonic scalpel which can do Re-sterilization. This procedure enables to have not only less invasive result but economical advantage.This method may give the great impact to the surgeons who are interesting in minimally invasive graft harvesting procedure.
METHODS: Only 2cm skin incision were made on two positions. Then Harmonic Scalpel (Ethicon Endo-Surgery Inc.Cincinnati,Ohio USA) and KARL STORZ-ENDOSKOPE system Bisleri endoscopic radial artery retractor (KARL STORZ GmbH & Co.Germany) were used for RA harvesiting.To acquire a further less invasiveness result, we selected the skin incision position 2cm proximal side from the wrist as harvesting radial artery. In addition, shaking or rubbing move with scalpel was possible to ultrasonically skeletonize SVG or radial artery harvesting. 79 CABG cases were indicated this endoscopic RA harvesting method with above procedure.
RESULTS: 76 CABG cases were performed by OFF-PUMP CABG. 3 cases were performed by On-Pump beating CABG. Male: Female = 49:30. 2 skin incisions (1cm or 2cm) were made on the patient’s arm. SVG HARVESTING ; 59 CABG cases were indicated the same endoscopic method. Single surgeon was performed all these cases. Mean harvest time was 32.1±8.6 minutes. Mean RA harvested length was 20.1±3.1 cm. 71 cases were performed postoperative angiography, then all grafts were patent and there were no anastomotic stenosis. There were no significant nerves parentheses’ with all patients’ arm that RA was harvested. There was no conversion from the endoscopic graft harvesting technique to the conventional method.
CONCLUSIONS: Current endoscopic procedure for SVG or Radial artery harvesting needed a high cost, because these are single use device.On the other hand, we do not use the single use device. Our procedure could have great economical advantages. We suspect that this harvesting procedure may have endoscopic method spread to cardiac surgery field because of economical and less invasive advantages.
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