Video-endoscopic dissection of multiple pedicled arterial grafts for use in minimally invasive coronary artery bypass surgery

Background We evaluated the possibility of video-endoscopic dissection of b oth internal thoracic arteries (ITAs) through the left thoracic approach an d right gastroepiploic artery (GEA) via a small laparoscopic access, for us e in minimally invasive coronary artery bypass surgery. Methods. The procedure was performed on twenty-two mongrel dogs. Three 10 m m ports were inserted in the left hemithorax to enable the introduction of a rigid 0-degree videoscope and forceps which allowed access to the left an d right ITAs. For dissection of the GEA, one 10 nun and two 5 nun ports wer e inserted in the paraumbilical region. Results. The left and right ITAs and the GEA were easily visualized and dis section and complete mobilization was achieved without injury, which was ch ecked by the presence of good blood now. The ITAs and GEA were divided dist ally, exteriorized through a small left anterior thoracotomy and the length of these three grafts were able to reach all of the left coronary artery b ranches. Conclusions, We have demonstrated, in dogs, the feasibility of video-assist ed dissection of both the left and right ITAs through the left thoracic app roach, without sternotomy, avoiding the risks of sternal complications and expanding its use for all patients. Furthermore, a third arterial conduit ( the RGA) can be used without requiring laparotomy.