Ohtsuka T, Takamoto S, Endoh M, Kotsuka Y, Oka T
Department of Cardiothoracic Surgery, University of Tokyo, Japan.
Surg Endosc. 2000 Jan;14(1):82-5. doi: 10.1007/s004649900018.
The Harmonic Scalpel (HS; Ethicon Endo-Surgery, Cincinnati, OH, USA) is an ultrasonic coagulator that generates less heat than electrocautery. We compared canine internal mammary arteries (IMAs) harvested using the HS or electrocautery and reviewed the early clinical outcome after thoracoscopic IMA takedown with the HS.
Using HS and bipolar electrocautery (BE), 51 and 49 IMA branches, respectively, in six mongrel dogs were divided. The divided branches were subjected to a pressure tolerance test. The impact of coagulation on the main trunk was investigated microscopically. Thoracoscopic IMA harvesting with the HS was performed in 41 patients. Seven human IMA segments including 10 branches were examined microscopically. Postoperative angiography of 40 IMA grafts (97.6%) was performed.
All the IMA branches withstood intraluminal pressures up to 250 mmHg. With BE, coagulation reached the adventitia of the main trunk in six segments (12.2%), but the HS caused no injury. Thoracoscopic IMA harvesting with excellent hemostasis was achieved using only the HS in all 41 patients. The main trunks of the human IMA segments were microscopically intact, and postoperative angiography demonstrated that the IMA grafts were intact.
The HS appears to be a reliable coagulator for thoracoscopic IMA harvesting with minimal damage.
谐波手术刀（HS；美国俄亥俄州辛辛那提市爱惜康内镜外科公司生产）是一种超声凝血器，其产生的热量比电灼少。我们比较了使用HS或电灼获取的犬类乳内动脉（IMA），并回顾了使用HS进行胸腔镜IMA离断术后的早期临床结果。
在6只杂种犬中，分别使用HS和双极电灼（BE）将51支和49支IMA分支进行分离。对分离出的分支进行耐压测试。通过显微镜研究凝血对主干的影响。41例患者使用HS进行胸腔镜IMA获取。对包括10个分支的7个人类IMA节段进行显微镜检查。对40例IMA移植物（97.6%）进行术后血管造影。
所有IMA分支均能承受高达250 mmHg的腔内压力。使用BE时，6个节段（12.2%）的凝血到达主干外膜，但HS未造成损伤。在所有41例患者中，仅使用HS就实现了具有良好止血效果的胸腔镜IMA获取。人类IMA节段的主干在显微镜下完整，术后血管造影显示IMA移植物完整。
HS似乎是一种可靠的凝血器，用于胸腔镜IMA获取时损伤最小。
