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The Journal of Cardiovascular Surgery 2000 February;41(1):7-9

Copyright © 2009 EDIZIONI MINERVA MEDICA

lingua: Inglese

Video-endoscopic dissection of multiple pedicled arterial grafts for use in minimally invasive coronary artery bypass surgery

Gomes W. J., Goldenberg A., Buffolo E., Losso L. C., Marcondes W., Rolla F., Imaeda C. J., Palma J. H., Goldenberg S.

From the Cardiovascular Surgery and Experimental Surgery Divisions, Department of Surgery, Escola Paulista de Medicina of Federal University of São Paulo, São Paulo, S.P., Brazil


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Back­ground. We eval­u­ated the pos­sibility of ­video-endo­scopic dis­sec­tion of ­both ­internal tho­racic ­arteries (ITAs) ­through the ­left tho­racic ­approach and ­right gas­troep­i­ploic ­artery (GEA) via a ­small lapar­os­copic ­access, for use in min­i­mally inva­sive cor­o­nary ­artery ­bypass sur­gery.
­Methods. The pro­ce­dure was per­formed on ­twenty-two mon­grel ­dogs. ­Three 10 mm ­ports ­were ­inserted in the ­left hem­i­thorax to ­enable the intro­duc­tion of a ­rigid 0-­degree vid­eo­scope and for­ceps ­which ­allowed ­access to the ­left and ­right ­ITAs. For dis­sec­tion of the GEA, one 10 mm and two 5 mm ­ports ­were ­inserted in the par­a­um­bil­ical ­region.
­Results. The ­left and ­right ­ITAs and the GEA ­were ­easily vis­u­al­ized and dis­sec­tion and com­plete mobil­iza­tion was ­achieved ­without ­injury, ­which was ­checked by the pres­ence of ­good ­blood ­flow. The ­ITAs and GEA ­were ­divided dis­tally, exte­ri­or­ized ­through a ­small ­left ante­rior thor­a­cotomy and the ­length of ­these ­three ­grafts ­were ­able to ­reach all of the ­left cor­o­nary ­artery ­branches.
Con­clu­sions. We ­have dem­on­strated, in ­dogs, the fea­sibility of ­video-­assisted dis­sec­tion of ­both the ­left and ­right ­ITAs ­through the ­left tho­racic ­approach, ­without ster­notomy, ­avoiding the ­risks of ­sternal com­pli­ca­tions and ­expanding its use for all ­patients. Fur­ther­more, a ­third arte­rial con­duit (the RGA) can be ­used ­without ­requiring lap­a­rotomy.

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