title: New instrument for robotic-enhanced skeletonized internal thoracic artery harvesting: triangular hook.
abstract: OBJECTIVE
  : The introduction of robotic surgery has generated innovations in minimally invasive coronary surgery, including instrumentation. We have developed a small instrument, named by us the Triangular Hook, that expedites robotic skeletonization of the internal thoracic artery and makes the procedure safer.
  
  
  METHODS
  : Bilateral skeletonized internal thoracic artery harvesting was performed in four dogs (weight, 22 to 36 kg), using the da Vinci surgical system (Intuitive Surgical, Inc, Sunnyvale, CA). One internal thoracic artery was harvested with the Triangular Hook; the other was harvested without it. Harvesting time was measured for each form of harvesting, with the data being reported as mean ± SD.
  
  
  RESULTS
  : All eight internal thoracic arteries were harvested successfully; they were patent at the end of harvesting. Significantly less time was required for the Triangular Hook (41.5 ± 2.8 minutes) than for harvesting without it (47.5 ± 3.9 minutes; P = 0.02).
  
  
  CONCLUSIONS
  : The Triangular Hook is practicable and safe in robotic skeletonization of the internal thoracic artery.
authors.affiliation: From the *Center for Robotics and Minimally Invasive Surgery, Brody School of Medicine at East Carolina University, Greenville, NC; and the †Department of Telesurgery and Geomedicine and the ‡Department of General and Cardiothoracic Surgery, Kanazawa University School of Medicine, Kanazawa, Japan.
authors.forename: Norihiko
authors.initials: N
authors.lastname: Ishikawa
authors.forename: You Su
authors.initials: YS
authors.lastname: Sun
authors.forename: L Wiley
authors.initials: LW
authors.lastname: Nifong
authors.forename: Go
authors.initials: G
authors.lastname: Watanabe
authors.forename: W Randolph
authors.initials: WR
authors.lastname: Chitwood