International Society For Minimally Invasive Cardiothoracic Surgery

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Advantage Of Using A Harmonic Scalpel In Mics Cabg Via Left Small Thoracotomy
Keita Kikuchi, Ph.D, Shinji Ogawa, MD, Kan Kaneko, MD, Akira Osanai, MD, Atsuyuki Mitsuishi.
Ichinomiya-Nishi Hospital, Ichinomiya, Japan.

OBJECTIVE: Several articles have reported benefits of the harmonic scalpel to harvest ITA in CABG. The harmonic scalpel may also provide these benefits in minimally invasive CABG. However, sternum and cartilage sometimes disturb our surgical view during harvesting ITAs in MICS CABG. In this situation, it is difficult to remove them with usual instruments for MICS. We have started MICS CABG program from 2012 and have used harmonic scalpel to harvest ITAs in MICS CABG. So, we would like to share our experience and technique of using harmonic scalpel in MICS CABG via left small thoracotomy.
METHODS: After opening the appropriate intercostal space. ITAs were harvested using a 32 cm dissecting hook type harmonic scalpel via port is put from same intercostal space of incision. Hook side of the tip is used to dissect between ITA and internal thoracic vein (ITV) carefully with sliding technique. Blunt side of the tip is used to remove fat tissue with very quick wiping method. ITAs are harvested with skeletonised fashion with these techniques. During harvesting ITAs, The harmonic scalpel can cut and seal brunches easily. When the sternum and the cartilage mask ITAs beneath the sternum, a harmonic scalpel can be used to remove them on level 5 using hook side of the tip. During distal anastomosis, we sometimes meet with deeply buried coronary artery unexpected or need to dissect coronary artery to get healthy coronary artery for distal anastomosis on the LAD. We can dissect fat tissue using a harmonic scalpel without bleeding.
CONCLUSIONS: Using a harmonic scalpel for harvesting ITAs and dissecting buried LAD is useful even in MICS CABG under direct vision. This new device provides reproducibility of harvesting ITAs and distal anastomosis in MICS CABG.

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