title: Thoracoscopic internal mammary artery harvest for MICABG using the Harmonic Scalpel.
abstract: BACKGROUND
  Thoracoscopic internal mammary artery (IMA) harvest is technically demanding, particularly on the left side. We have devised a Harmonic Scalpel (Ethicon Endo-Surgery, Cincinnati, OH) technique to facilitate this procedure, and describe our clinical experience here.
  
  
  METHODS
  The Harmonic Scalpel functions with ultrasonic energy, producing 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 harvested from the upper margin of the first rib or higher to the lower margin of the fifth rib thoracoscopically using the Harmonic Scalpel with a hook blade.
  
  
  RESULTS
  In each case, the IMA harvest was completed thoracoscopically with only the Harmonic Scalpel, decreasing instrument transfers. Each vascular branch was coagulated without charring and was transected with excellent hemostasis. Smokeless views were provided. In the first 17 harvests, Doppler studies 3 months after the procedures demonstrated patent IMAs to the coronary circulation.
  
  
  CONCLUSIONS
  The Harmonic Scalpel facilitates thoracoscopic IMA harvest and is expected to minimize hyperthermic damage of the IMA.
authors.affiliation: Department of Cardiac Surgery, The Christ and Jewish Hospitals, University of Cincinnati, Ohio, USA.
authors.forename: T
authors.initials: T
authors.lastname: Ohtsuka
authors.forename: R K
authors.initials: RK
authors.lastname: Wolf
authors.forename: L F
authors.initials: LF
authors.lastname: Hiratzka
authors.forename: P
authors.initials: P
authors.lastname: Wurnig
authors.forename: J B
authors.initials: JB
authors.lastname: Flege
mesh_terms: D001026:Coronary Artery Bypass / Q000295:instrumentation*; D019723:Endoscopes; D006801:Humans; D008323:Mammary Arteries / Q000601:surgery*; D013906:Thoracoscopy; D014465:Ultrasonics