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Endoscopic Radial Artery Harvesting: a Versatile Technique Without CO2 Insufflation and Combining a Reusable Retractor With Different Vessel Sealing Systems
Gianluigi Bisleri, MD, Claudio Muneretto, MD.
University of Brescia Medical School, Brescia, Italy.

OBJECTIVE: The preferred approach for endoscopic radial artery harvesting (ERAH) to date has been based on the use of sealed systems, which may potentially jeopardize the quality of conduit. We therefore sought to investigate the feasibility of a different, simplified minimally invasive radial artery harvesting approach combining a novel resterilizable retractor with different vessel sealing systems.
METHODS: Seventy-two(72) patients underwent ERAH combining a dedicated stainless steel resterilizable retractor with two different vessel sealing systems: in 35 patients, a bipolar radiofrequency(BR) device with nanoscale control system and tissue-dynamic energy delivery was utilized, while in the remaining 37 patients a BR device with sensing technology allowing for analysis in tissue impedance and adjusting energy output accordingly; both devices allows for sequential sealing and tissue division and are FDA-approved for vessel sealing up to 7 mm. A 2 cm longitudinal incision of the forearm is performed at the wrist crease; the distal part of the radial artery is dissected under direct vision by means of the vessel sealing system. Once enough space is created, the endoscopic retractor is advanced towards the antecubital fossa while fascial division is carried out. A careful dissection around the pedicled radial artery is then performed by means of the vessel sealing systems. No CO2 insufflation nor any arm tourniquet is utilized.
RESULTS: Mean harvest time was 23±12 min. No bleeding requiring conversion to the open technique was observed during all procedures. No additional clipping was required. The radial artery could be harvested full length without any macroscopic damage in terms of tissutal charring or sticking. No macroscopic spasm of the radial artery occurred. No complications, either in terms of wound problems, haematomas, neurological impairment occurred.
CONCLUSIONS: ERAH can be safely and effectively performed combining a reusable retractor and different models of vessel sealing systems.This versatile and cost-effective approach avoids the drawbacks and potential complications associated with the use of sealed systems and active CO2 insufflation.


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