title: Division of the brachioradialis muscle: a modification of the current technique in endoscopic radial artery harvesting.
abstract: BACKGROUND
  Utilization of the radial artery as a conduit for coronary artery bypass grafting has increased significantly over the past 8 years. Concurrently, minimally invasive surgical techniques have been increasingly applied resulting in improved aesthetics, less pain, and decreased morbidity and length of hospital stay. Endoscopic radial artery harvesting (ERAH) has been shown to be of benefit to patients undergoing coronary artery bypass grafting. The brachioradialis is a recognized limitation in ERAH. To date, the standard operative techniques for ERAH have included maintaining the integrity of the brachioradialis muscle. Objective. The aim of this study was to assess the effect of dividing the medial border of the brachioradialis muscle during ERAH.
  
  
  METHODS
  We performed ERAH on 9 cadaveric arms using standard endoscopic vein harvesting equipment (30-degree/5-mm endoscope, subcutaneous retractor, and pig-tail vessel dissector) and ultrasonic harmonic coagulating shears. In 5 cadaveric arms, the medial aspect of the brachioradialis muscle was preserved during the dissection. In 4 arms, the medial border of the brachioradialis muscle was divided. All 9 harvests were timed and compared. At the completion of the endoscopic dissection, all 9 arms were opened and examined for neurovascular injury.
  
  
  RESULTS
  In cadaveric arms, modifying the current ERAH technique by dividing the medial border of the brachioradialis muscle resulted in a visible increase in tunnel size. In the group where the brachioradialis muscle was divided, a statistically significant reduction in harvest time of 32% was observed (P = .02). Post-harvest examination revealed no gross neurovascular injury; specifically, no injuries to the superficial branches of the radial nerve or the lateral antebrachial cutaneous nerves were identified.
  
  
  CONCLUSIONS
  Division of the medial border of the brachioradialis muscle during endoscopic radial artery harvesting appears to be a safe technique modification that subjectively improves working space and vision of vital structures, facilitating ease of the procedure. Objectively, division of the medial border of the brachioradialis muscle resulted in a statistically significant reduction in harvest time in cadaveric arms when compared with the current technique of ERAH. A clinical pilot study to verify the efficacy and safety of this technique modification is warranted.
authors.affiliation: Cleveland Clinic Florida, Section of Cardiothoracic Surgery, Weston, Florida 33331, USA. nickumc@ccf.org
authors.forename: Christopher W
authors.initials: CW
authors.lastname: Nickum
authors.forename: W Douglas
authors.initials: WD
authors.lastname: Boyd
authors.forename: Richard J
authors.initials: RJ
authors.lastname: Novick
authors.forename: Eugene H
authors.initials: EH
authors.lastname: Blackstone
authors.forename: Carolyn
authors.initials: C
authors.lastname: Apperson-Hanson
authors.forename: John A
authors.initials: JA
authors.lastname: McAuliffe
mesh_terms: D002102:Cadaver; D001026:Coronary Artery Bypass / Q000379:methods; D004724:Endoscopy / Q000379:methods*; D005542:Forearm / Q000033:anatomy & histology / Q000601:surgery; D006801:Humans; D019060:Minimally Invasive Surgical Procedures / Q000379:methods*; D018482:Muscle, Skeletal / Q000601:surgery*; D017534:Radial Artery / Q000033:anatomy & histology* / Q000601:surgery*; D020858:Tissue and Organ Harvesting / Q000379:methods*; D014656:Vascular Surgical Procedures / Q000379:methods*