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3D endscopic harvesting of left internal thoracic artery using harmonic scarpel
Takahiro Takemura, Yujirou Kawai, Hirokazu Miitsu, Gentaku Hama, Yasuyuki Yoyota, Yasutoshi Tsuda, Kazuaki Shiratori.
Saku Central Hospital, Saku, Japan.

An important step of Minimally invasive coronary artery bypass grafting is harvesting of the left internal mammary artery (LIMA). Harvesting of the LIMA usually performed under direct vision via mini thoracotomy or using robotic assistance. However, complete graft harvesting of the IMA is difficult under direct vision and robotic assistance is not usually used in our country and requires high costs.
A 30 degrees rigid 3D endoscope was inserted through a 11-mm port in the 5th/6th intercostal space (ICS) at the anterior axillary line. The dissection instrument (Ultracision Harmonic Scalpel) was inserted (5-mm port) in the 4 or 3yh ICS at the anterior axillary line and the endo-forceps (5-mm port) in the 4 or 5th ICS mini lateral thoracotomy.
3D endscopic harvesting of LIMA permits dissection from subclavian artery to the 5th intercostal space. It was performed by the technique of skeletonization as same quality as usual procedure thorough full sternotomy.
Ultrasonic harvesting of a skeletonized IMA using 3D endoscope is a non-traumatic preparatory technique that reduces the costs and that can be performed safely and good quality.

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