THORACOSCOPIC INTERNAL MAMMARY ARTERY HARVEST FOR MICABG USING THE HARMONIC SCALPEL

Background. Thoracoscopic internal mammary artery (IMA) harvest is tec hnically demanding, particularly on the left side. We have devised a H armonic Scalpel (Ethicon Endo-Surgery, Cincinnati, OH) technique to fa cilitate this procedure, and describe our clinical experience here. Me thods. The Harmonic Scalpel functions with ultrasonic energy, producin g less smoke and lower heat than regular electrocautery. A total of 27 (22 left and 5 right) pedicles of the IMA in 23 patients were harvest ed from the upper margin of the first rib or higher to the lower margi n of the fifth rib thoracoscopically using the Harmonic Scalpel with a hook blade. Results. In each case, the IMA harvest was completed thor acoscopically with only the Harmonic Scalpel, decreasing instrument tr ansfers. Each vascular branch was coagulated without charring and was transected with excellent hemostasis. Smokeless views were provided. I n the first 17 harvests, Doppler studies 3 months after the procedures demonstrated patent IMAs to the coronary circulation. Conclusions. Th e Harmonic Scalpel facilitates thoracoscopic IMA harvest and is expect ed to minimize hyperthermic damage of the IMA. (C) 1997 by The Society of Thoracic Surgeons.