Skeletonised Left Internal Mammary Artery Harvest Using a Harmonic Scalpel
2 years ago
The left intermal mammary artery (LIMA) is universally used as the gold standard conduit for coronary bypass grafting surgery. We present our technique of in situ left internal mammary artery harvest using a harmonic scalpel (*brand unrevealed*). The harmonic blade facilitates easy atraumatic skeletonisation of the artery without the need to use any clips for the branches.
The advantages of using a harmonic scalpel include:
1) a long conduit suitable for sequential grafting
2) minimising graft spasm from frequent handling of the graft or pinching of the body of the artery by side-branch vessel clips
3) reduction in collateral thermal injury to the chest wall and nearby vessels compared to diathermy harvest
4) faster conduit harvest
5) reduction in surgeon fatigue, as there is no need for frequent instrument exchanges required to clip and cut side branches
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