Totally Endoscopic Internal Thoracic Artery Harvesting with Efficient Setup Modifications for Minimally Invasive Direct Coronary Artery Bypass Grafting.

Yoshihiro Goto, Yui Ogihara, Sho Takagi, Junji Yanagisawa, Yasuhide Okawa
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Abstract

Minimally invasive direct coronary artery bypass grafting for the left anterior descending artery is a well-established technique; however, harvesting the internal thoracic artery is challenging, particularly with endoscopic approaches. In this study, 12 patients underwent internal thoracic artery harvesting using a three-dimensional endoscope with a three-port system (one incision plus two ports). Working space was established by elevating the chest wall upward using hooks anchored at the main incision site. To enhance operability, the positions of the camera and instruments were strategically adjusted within the existing ports, obviating the need for additional access points. All patients achieved graft patency. No complications, such as internal thoracic artery injury, were observed, and no patient required conversion into median sternotomy. This approach minimizes invasiveness while maintaining effectiveness, allowing for adequate dissection of the internal thoracic artery without necessitating expansion of the existing surgical setup.

微创直接冠状动脉搭桥术的全内窥镜胸内动脉采集及有效的设置修改。
微创直接冠状动脉旁路移植术治疗左前降支是一项成熟的技术;然而,切除胸内动脉是具有挑战性的,尤其是内窥镜手术。在这项研究中,12名患者使用三维内窥镜进行胸内动脉切除,该内窥镜采用三孔系统(一个切口加两个孔)。使用锚定在主切口部位的挂钩将胸壁向上抬高,建立工作空间。为了提高可操作性,在现有港口内战略性地调整了摄像机和仪器的位置,从而避免了需要额外的接入点。所有患者均达到移植物通畅。无胸内动脉损伤等并发症,无患者需要转胸骨正中切开术。该入路在保持有效性的同时最大限度地减少了侵入性,允许在不需要扩大现有手术设置的情况下充分剥离胸内动脉。
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