Endoscopic Internal Thoracic Artery Harvesting with Changes in Scope Position

Abstract

Although minimally invasive direct coronary artery bypass (MIDCAB) is a less invasive procedure, internal thoracic artery (ITA) harvesting is difficult. A 65-year-old woman was advised to undergo MIDCAB for recurrent in-stent restenosis. We harvested the ITA using three-dimensional endoscopy without robotics and determined the scope position using enhanced computed tomography. We changed the camera installation between the wound and the camera port, according to the harvesting site with a harmonic scalpel using the skeletonized technique. We harvested the ITA from the subclavian vein level superiorly to the xyphoid process level inferiorly.

Concomitant surgery of minimally invasive direct coronary artery bypass with left atrium appendage closure

“…We previously reported a safe and useful lateral approach for MIDCAB using 3D endoscopy without robotic system and performed multiple arterial bypasses using an incision on the left side 5 12. We were able to safely harvest the ITA through an endoscopic approach with excellent resolution.…”

“…A posterolateral thoracotomy incision can provide excellent exposure to the lateral surface of the heart, including the left atrial appendage (LAA), whereas in performing MIDCAB, a more distal anastomosis is required, necessitating the harvest of the internal thoracic artery (ITA) over a longer length. We previously reported a lateral mini-thoracotomy performed using a 3D endoscopy for MIDCAB 5. In this case, we used 3D endoscopy to perform total endoscopic harvesting of the full-length ITA.…”

Combination of endoscopic internal thoracic artery harvest and proximal anastomoses on the descending aorta in minimally invasive coronary artery bypass grafting

“…We previously reported a technique for total endoscopic ITA harvesting using 3D endoscopy without a robotic system. 5 The 3D endoscope has an enhanced ability for image analysis and enables a more reliable visualisation of the branches of the ITA than direct vision. 3D endoscopy offers the advantage of a lower running cost than robotic systems.…”

“…Previously, a minithoracotomy was performed using minimally invasive direct coronary artery bypass grafting (MIDCAB’s) three-dimensional (3D) endoscopy. 5 The endoscopic ITA harvesting enables us to minimise the incision length and perform lateral thoracotomy. The combination of endoscopic ITA harvesting and small thoracotomy incision led to a reduction in the pain issue.…”

“…Pain is a major problem with this method because the incision must be extended laterally for anastomosis of the descending aorta. Previously, a minithoracotomy was performed using minimally invasive direct coronary artery bypass grafting (MIDCAB’s) three-dimensional (3D) endoscopy 5. The endoscopic ITA harvesting enables us to minimise the incision length and perform lateral thoracotomy.…”