FIBEROPTIC-GUIDED CO2-LASER FOR HARVESTING OF THE INTERNAL MAMMARY ARTERY

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.