Yong Chae Jung, Yooyoung Chong, Min-Woong Kang, Sung Joon Han, Hyun Jin Cho, Sang-Jun Park, Man-Shik Shim
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Unlike traditional instruments, the shear-tip Harmonic scalpel offers more precise vessel branching control, while minimizing damage to surrounding tissues. In this study, we assessed the utility of the shear-tip Harmonic scalpel in patients undergoing minimally invasive coronary artery bypass grafting (MICABG).</p><p><strong>Methods: </strong>From April 2019 to May 2023, a total of 40 patients underwent MICABG. The IMA was harvested using the shear-tip Harmonic scalpel with a clipless skeletonized technique. In this cohort, 5 patients underwent complete endoscopic harvesting, while 34 patients underwent direct visualization harvesting through minimal thoracotomy. Graft patency was assessed by measuring a Doppler flowmeter in the bypass conduit.</p><p><strong>Results: </strong>Successful graft patency was achieved in all patients. The mean duration of IMA harvesting was 87 min. In total, 38 of the 40 patients underwent MICABG without the need for cardiopulmonary bypass, ensuring a stable procedure. There were no graft-related events or complications observed in any of the patients, and all were discharged without any issues. During a median follow-up period of 15.2 months, only one patient experienced graft occlusion necessitating intervention.</p><p><strong>Conclusions: </strong>The utilization of shear-tip Harmonic scalpel for IMA harvesting in MICABG is feasible and yields stable early results.</p>","PeriodicalId":17542,"journal":{"name":"Journal of thoracic disease","volume":null,"pages":null},"PeriodicalIF":2.1000,"publicationDate":"2024-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11228713/pdf/","citationCount":"0","resultStr":"{\"title\":\"Clipless internal mammary artery harvesting for minimally invasive coronary artery bypass grafting using the shear-tip harmonic scalpel.\",\"authors\":\"Yong Chae Jung, Yooyoung Chong, Min-Woong Kang, Sung Joon Han, Hyun Jin Cho, Sang-Jun Park, Man-Shik Shim\",\"doi\":\"10.21037/jtd-23-1810\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>The internal mammary artery (IMA) is the most commonly used graft in coronary artery bypass grafting (CABG) because of its superior long-term patency rate. 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引用次数: 0
摘要
背景：乳内动脉（IMA）是冠状动脉旁路移植术（CABG）中最常用的移植物，因为其长期通畅率较高。然而，IMA 的直径较小，这给操作带来了挑战，而且在采集过程中可能发生的任何血管损伤都会严重影响手术效果。在 IMA 采集过程中，首要任务是确保安全有效的止血，避免直接损伤血管，同时确保安全、可靠地结扎血管分支。为此，使用多种手术器械的方法层出不穷。与传统器械不同，剪切尖端的 Harmonic 手术刀能更精确地控制血管分支，同时最大限度地减少对周围组织的损伤。在这项研究中，我们评估了剪切尖 Harmonic 手术刀在接受微创冠状动脉旁路移植术（MICABG）患者中的实用性：2019年4月至2023年5月，共有40名患者接受了微创冠状动脉旁路移植术（MICABG）。使用剪尖 Harmonic 手术刀和无夹镂空技术切除 IMA。在这批患者中，5 名患者接受了完整的内窥镜下切除术，34 名患者通过最小胸廓切开术接受了直视下切除术。通过测量旁路导管中的多普勒血流计来评估移植物的通畅性：结果：所有患者都成功实现了移植物通畅。采集 IMA 的平均时间为 87 分钟。在 40 位患者中，共有 38 位接受了 MICABG，无需进行心肺旁路，确保了手术的稳定性。所有患者均未发生移植物相关事件或并发症，全部顺利出院。在中位 15.2 个月的随访期间，只有一名患者出现移植物闭塞，需要进行干预：结论：在 MICABG 中使用剪切尖 Harmonic 手术刀采集 IMA 是可行的，并能获得稳定的早期效果。
Clipless internal mammary artery harvesting for minimally invasive coronary artery bypass grafting using the shear-tip harmonic scalpel.
Background: The internal mammary artery (IMA) is the most commonly used graft in coronary artery bypass grafting (CABG) because of its superior long-term patency rate. However, its small diameter poses challenges in handling, and any vascular damage that may occur during harvesting can significantly affect surgical outcomes. The primary focus during IMA harvesting is to ensure safe and effective hemostasis without direct vascular injury, while ensuring secure and reliable ligation of the vascular branches. Various methods using multiple surgical instruments have been used for this purpose. Unlike traditional instruments, the shear-tip Harmonic scalpel offers more precise vessel branching control, while minimizing damage to surrounding tissues. In this study, we assessed the utility of the shear-tip Harmonic scalpel in patients undergoing minimally invasive coronary artery bypass grafting (MICABG).
Methods: From April 2019 to May 2023, a total of 40 patients underwent MICABG. The IMA was harvested using the shear-tip Harmonic scalpel with a clipless skeletonized technique. In this cohort, 5 patients underwent complete endoscopic harvesting, while 34 patients underwent direct visualization harvesting through minimal thoracotomy. Graft patency was assessed by measuring a Doppler flowmeter in the bypass conduit.
Results: Successful graft patency was achieved in all patients. The mean duration of IMA harvesting was 87 min. In total, 38 of the 40 patients underwent MICABG without the need for cardiopulmonary bypass, ensuring a stable procedure. There were no graft-related events or complications observed in any of the patients, and all were discharged without any issues. During a median follow-up period of 15.2 months, only one patient experienced graft occlusion necessitating intervention.
Conclusions: The utilization of shear-tip Harmonic scalpel for IMA harvesting in MICABG is feasible and yields stable early results.
期刊介绍：
The Journal of Thoracic Disease (JTD, J Thorac Dis, pISSN: 2072-1439; eISSN: 2077-6624) was founded in Dec 2009, and indexed in PubMed in Dec 2011 and Science Citation Index SCI in Feb 2013. It is published quarterly (Dec 2009- Dec 2011), bimonthly (Jan 2012 - Dec 2013), monthly (Jan. 2014-) and openly distributed worldwide. JTD received its impact factor of 2.365 for the year 2016. JTD publishes manuscripts that describe new findings and provide current, practical information on the diagnosis and treatment of conditions related to thoracic disease. All the submission and reviewing are conducted electronically so that rapid review is assured.
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