Ultrasonic coagulator for video-assisted internal mammary artery harvest

Background: The Harmonic Scalpel (HS; Ethicon Endo-Surgery, Cincinnati, OH, USA) is an ultrasonic coagulator that generates less heat than electrocaut ery. We compared canine internal mammary arteries (TMAs) harvested using th e HS or electrocautery and reviewed the early clinical outcome after thorac oscopic IMA takedown with the HS. Methods: Using HS and bipolar electrocautery (BE), 51 and 49 IMA branches, respectively, in six mongrel dogs were divided. The divided branches were s ubjected to a pressure tolerance test. The impact of coagulation on the mai n trunk was investigated microscopically. Thoracoscopic IMA harvesting with the HS was performed in 41 patients. Seven human IMA segments including 10 branches were examined microscopically. Postoperative angiography of 40 IM A grafts (97.6%) was performed. Results: All the IMA branches withstood intraluminal pressures up to 250 mm Hg. With BE, coagulation reached the adventitia of the main trunk in six se gments (12.2%), but the HS caused no injury. Thoracoscopic IMA harvesting w ith excellent hemostasis was achieved using only the HS in all 41 patients. The main trunks of the human IMA segments were microscopically intact, and postoperative angiography demonstrated that the IMA grafts were intact. Conclusion: The HS appears to be a reliable coagulator for thoracoscopic IM A harvesting with minimal damage.