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A Technique Of The LIMA Harvested
Dapeng Yu, XiuXiu Zhang, Yan Zhang;
Liaocheng Cardiac Hospital, Liaocheng, China
BACKGROUND:To explore the feasibility and safety of performing a complete thoracoscopic ultrasonic scalpel procedure to harvest the left internal mammary artery (LIMA)
METHODS:The pleural and fascial tissues were incised approximately 0.5 cm to the left side of the LIMA, revealing the gap between the LIMA and the chest wall. The LIMA was cautiously separated both cranially and caudally, keeping the ultrasonic scalpel head away from the LIMA to prevent thermal injury. In cases where the vessel adhered tightly to the rib, the vessel was first detached from the upper and lower intercostal spaces and then gently separated using the ultrasonic scalpel or scissors, if needed. Branch vessels were cut with the ultrasonic scalpel approximately 1-2 mm from the main trunk. If the ultrasonic scalpel came close to the LIMA, the scalpel head was gently rotated to create distance. The internal tissue layers around the LIMA were incised to join it with the accompanying vein, creating a vascular graft extending from the first intercostal space to the fifth or sixth intercostal space on the cranial and caudal sides. The distal end was ligated after administering heparin at 200 mg/kg.
RESULTS: We performed a total of 200 thoracoscopic harvestes of the LIMA, and there was one case of LIMA injury.
CONCLUSIONS: The complete thoracoscopic ultrasonic scalpel-assisted LIMA harvesting has the potential to be a feasible and safe approach.
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