International Society For Minimally Invasive Cardiothoracic Surgery

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No Touch Saphenous Vein Harvesting Thorough Mini-incisions By An Electrothermal Bipolar Vessel Sealing Device
Ichiro Hayashi1, Ichiro Kashima2, Eiji Yoshikawa1.
1Self Defense Forces Central Hospital, Tokyo, Japan, 2Misyuku Hospital, Tokyo, Japan.

OBJECTIVE: No-touch (NT) saphenous vein (SV) harvesting preserves the adventitial vaso vasorum, prevent medial ischemia, and is associated with an improved short-term and long-term vein graft patency. However, the wound complications after NT-SV harvesting are reported to be more significant than associated skeletonized technique. The majority of the complications are caused by thermal injury resulting from the use of heat-generating monopolar electrocautery. The superficial inguinal lymph nodes and large lymph vessels accompany the SV anatomically and are prone to damage during the harvesting, which may also be associated with a higher rate of the complications. The electrothermal bipolar vessel sealing device (EBVSD) has been designed to aid in coagulation and dissection with less thermal spread than conventional electrocautery. We introduced EBVSD to NT-SV harvesting thorough mini-incisions, considering the ability of this method to firmly seal the lymphatic vessels. The aim of this study was to clarify whether EBVSD contributed to the feasibility of this minimally NT-SV harvesting.
METHODS: After anesthetic induction, ultrasonography mapping was performed to assess the course and quality of SV. Some surgical instruments have been devised to facilitate with small incisions. Through small incisions made at levels of upper thigh, knee and ankle, a cordless retractor with a built-in LED light source was inserted to enhance the visualization of the operating field and brightens up the operating field. The SV was harvested with a pedicle of surrounding tissue of about 5 mm attached to the main trunk of the SV using EBVSD. Due to the lack of smooth muscle cells in the wall of lymphatic vessels, and a lack of thrombocytes in lymphatic fluids, it was attempt to seal surrounding connective tissue together with the lymphatic vessels to reinforce the sealing effect.
RESULTS: NT-SV was harvested successfully without any complications through mini incisions. After insertion of a 15Fr. round silicone drain in the SV harvest site, the skin is closed with running suture with absorbable monofilament suture without postoperative complications.
CONCLUSIONS: This technique is highly possible and could have certain vessels sealing and improved workability and post-operative outcome. Further research is required to refine technology and techniques.

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