title: Video-endoscopic dissection of multiple pedicled arterial grafts for use in minimally invasive coronary artery bypass surgery.
abstract: BACKGROUND
  We evaluated the possibility of video-endoscopic dissection of both internal thoracic arteries (rTAs) through the left thoracic approach and right gastroepiploic artery (GEA) via a small laparoscopic access, for use in minimally invasive coronary artery bypass surgery.
  
  
  METHODS
  The procedure was performed on twenty-two mongrel dogs. Three 10 mm ports were inserted in the left hemithorax to enable the introduction of a rigid 0-degree videoscope and forceps which allowed access to the left and right ITAs. For dissection of the GEA, one 10 mm and two 5 mm ports were inserted in the para-umbilical region.
  
  
  RESULTS
  The left and right ITAs and the GEA were easily visualized and dissection and complete mobilization was achieved without injury, which was checked by the presence of good blood flow. The ITAs and GEA were divided distally, exteriorized through a small left anterior thoracotomy and the length of these three grafts were able to reach all of the left coronary artery branches.
  
  
  CONCLUSIONS
  We have demonstrated, in dogs, the feasibility of video-assisted dissection of both the left and right ITAs through the left thoracic approach, without sternotomy, avoiding the risks of sternal complications and expanding its use for all patients. Furthermore, a third arterial conduit (the RGA) can be used without requiring laparotomy.
authors.affiliation: Department of Surgery, Escola Paulista de Medicina of Federal University of São Paulo, Brazil.
authors.forename: W J
authors.initials: WJ
authors.lastname: Gomes
authors.forename: A
authors.initials: A
authors.lastname: Goldenberg
authors.forename: E
authors.initials: E
authors.lastname: Buffolo
authors.forename: L C
authors.initials: LC
authors.lastname: Losso
authors.forename: W
authors.initials: W
authors.lastname: Marcondes
authors.forename: F
authors.initials: F
authors.lastname: Rolla
authors.forename: C J
authors.initials: CJ
authors.lastname: Imaeda
authors.forename: J H
authors.initials: JH
authors.lastname: Palma
authors.forename: S
authors.initials: S
authors.lastname: Goldenberg
mesh_terms: D017546:Angioscopy; D000818:Animals; D001026:Coronary Artery Bypass / Q000295:instrumentation*; D004285:Dogs; D004867:Equipment Design; D019060:Minimally Invasive Surgical Procedures / Q000295:instrumentation*; D013895:Thoracic Arteries / Q000637:transplantation*; D014741:Video Recording / Q000295:instrumentation*