Harvesting of the gastroepiploic artery using a novel hybrid bipolar ultrasonic energy device.

Until now, scissors, clips and electrocautery have been used to harvest the gastroepiploic artery (GEA) for grafting. Because this artery has many branches and large fragile satellite veins tangled around it, conventional methods are not suitable for quick harvesting without bleeding. In order to harvest the GEA easily and efficiently, a skeletonized technique using an ultrasonic scalpel was developed, but the blade of this device was not well designed for fine tissue dissection.  In order to address this problem, we have developed an alternative harvesting technique using a hybrid bipolar/ultrasonic energy device. This hybrid device integrates both electrical bipolar energy and ultrasonic frictional heat energy and is thus more versatile than traditional energy devices.  In addition, it achieves faster dissection speed while offering similar bursting pressure and acceptable thermal spread. Finally, our device has an improved blade design that is suitable for fine tissue dissection.  This video tutorial demonstrates our use of this new hybrid energy device and shows how it enables the surgeon to harvest the GEA quickly, safely, with little bleeding, and with less instrument exchange.