title: Myocardial revascularization through a mini-thoracotomy with thoracoscopic assistance.
abstract: OBJECTIVE
  Left internal mammary artery harvesting through a mini-thoracotomy makes gaining the proximal portion of this vessel very difficult and exposes the patient to the risk of chest wall trauma due to excessive spreading of the ribs. The adoption of video thoracoscopic assistance can give several advantages to the procedure.
  
  
  METHODS
  With the patient in a 30 degrees left-side-up thoracotomy position, a 8-12 cm anterior thoracotomy is performed in the left fourth or fifth intercostal space. Two thoracoscopic ports are inserted in the third and fourth left intercostal spaces in the midaxillary line. Complete mobilization of the left internal mammary artery is performed with a mixed surgical and thoracoscopic technique.
  
  
  RESULTS
  Since July 1996, 12 patients underwent myocardial revascularization with the left internal mammary artery through a mini-thoracotomy, with the aid of video assisted thoracoscopy. There were no deaths or perioperative infarctions. Mean hospital stay was 4 days (3-6). In nine patients a postoperative angiographic study was performed: in all cases the length of the mammary artery pedicle was adequate; one patient underwent a successful angioplasty on a narrowed anastomosis on the left anterior descending artery. In another patient the left internal mammary artery had been grafted to a diagonal branch. In all other cases angiography showed good results.
  
  
  CONCLUSIONS
  Thoracoscopic assistance helps achieving complete mobilization of the left internal mammary artery, maximizing its useful length, without an extended thoracotomy.
authors.affiliation: Division of Cardiovascular Surgery, Clinica Villa Maria Pia, Turin, Italy. jerichostar@,iname.com
authors.forename: G L
authors.initials: GL
authors.lastname: Martinelli
authors.forename: M
authors.initials: M
authors.lastname: Cassese
authors.forename: G
authors.initials: G
authors.lastname: Speziali
authors.forename: A
authors.initials: A
authors.lastname: Testa
authors.forename: M
authors.initials: M
authors.lastname: Lirici
authors.forename: M
authors.initials: M
authors.lastname: Bobbio
authors.forename: M
authors.initials: M
authors.lastname: Braccio
authors.forename: M
authors.initials: M
authors.lastname: Diena
mesh_terms: D004724:Endoscopy / Q000379:methods*; D005260:Female; D006801:Humans; D007387:Internal Mammary-Coronary Artery Anastomosis / Q000379:methods*; D008297:Male; D008875:Middle Aged; D013906:Thoracoscopy / Q000379:methods*; D013908:Thoracotomy / Q000379:methods