E. Raanani et al., FIBEROPTIC-GUIDED CO2-LASER FOR HARVESTING OF THE INTERNAL MAMMARY ARTERY, European journal of cardio-thoracic surgery, 11(6), 1997, pp. 1093-1096
Objective: The internal mammary artery is the preferred conduit in cor
onary artery bypass grafting. Although most centers use electrocautery
to dissect the internal mammary artery, it has several disadvantages.
The purpose of this study in a canine model was to evaluate and compa
re a fiberoptic CO2 laser device versus electrocautery for harvesting
the internal mammary artery. Material and methods: In ten mongrel dogs
, both internal mammary arteries with their surrounding pedicles, were
dissected from the thoracic wail, using a low-current electrocautery
for one artery and a continuous wave, fiberoptic-guided CO2 laser (13
watts) for the contralateral vessel. Blood flow through the vessels wa
s measured immediately after dissection. Results: Mean flow through th
e laser dissected arteries was 71.3 +/- 23.7 ml/min versus 52.9 +/- 16
.5 ml/min in those dissected using electrocautery. Histological examin
ation of the chest wall specimens dissected with electrocautery showed
the presence of necrosis, edema and hemorrhage surrounding the muscle
, while the specimens dissected with the laser revealed only a narrow
area of burn on the surgical margins of the muscle. The laser-assisted
dissection was more accurate, as easy, and almost as fast as with the
use of electrocautery. Conclusions: Stripping of the internal mammary
artery with the fiberoptic CO2 laser offers a promising alternative t
o electrocautery. Owing to its greater accuracy, the laser technique m
ay reduce the likelihood of damaging the endothelial lining of the dis
sected vessel. By reducing the degree of soft tissue damage, the CO2 l
aser may also lower the incidence of sternal wound infection and reduc
e postoperative chest wall pain and dysesthesia. (C) 1997 Elsevier Sci
ence B.V.