Advantages of the ultrasonic harmonic scalpel for radial artery harvesting.
The aim of the study was to examine the safety and effectiveness of the Harmonic Scalpel for reducing spasm caused by thermal injury during radial artery harvesting. The study sample included 100 candidates undergoing coronary artery bypass grafting. In half the patients, radial artery harvesting was performed using the ultrasonic Harmonic Scalpel equipped with coagulating curved shears and a 14 cm scissor-grip handle and in the other half, hemostatic clips, scissors, and minimal electrocautery were employed. Comparison of outcome between the groups showed that radial artery harvesting with the Harmonic Scalpel was associated with a shorter harvesting time, lower frequency of spasm, larger internal diameter of the radial artery graft, and a significantly reduced need for clips to control bleeding than the standard method. In addition, there were no cases of hematoma or superficial wound infection in the arm, and no postoperative reduction in soft touch sensation or objective pin-prick sensation. In conclusion, the Harmonic Scalpel provides excellent control of bleeding without the need for potentially damaging electrocautery, and with a markedly decreased use of hemostatic clips. Harvesting time is also shorter. The minimized thermal injury decreases the rate of radial artery spasm. Further studies using additional objective measures are currently underway to confirm these findings.
Georghiou
Georgios P
GP
Department of Cardiothoracic Surgery, Rabin Medical Center, Beilinson Campus, Petah Tiqva 49100, Israel. georgios@clalit.org.il
Stamler
Alon
A
Berman
Marius
M
Sharoni
Erez
E
Vidne
Bernardo A
BA
Sahar
Gideon
G
D001026:Coronary Artery Bypass; D004564:Electrocoagulation / Q000009:adverse effects / Q000295:instrumentation*; D006801:Humans; D011183:Postoperative Complications / Q000517:prevention & control; D017534:Radial Artery / Q000503:physiopathology* / Q000637:transplantation*; D020858:Tissue and Organ Harvesting / Q000295:instrumentation*; D016896:Treatment Outcome; D014465:Ultrasonics; D014661:Vasoconstriction / Q000502:physiology; D014664:Vasodilation / Q000502:physiology