Ohtsuka T, Takamoto S, Kohno T, Wolf R K
Department of Cardiothoracic Surgery, University of Tokyo, Japan.
Kyobu Geka. 1998 Apr;51(4):292-5.
We have developed a video-assisted mammary harvest technique using the Harmonic Scalpel. The clinical method and results are reported here. Since Nov. 1995, 70 left and 5 right internal mammary arteries (L/RIMAs) were taken down thoracoscopically and utilized for minimally invasive coronary artery bypass grafting. Each of the IMAs was harvested up to the upper margin of the first rib or higher and down to the bifurcation. Coagulation and cutting of the branches were achieved with excellent hemostasis using only the Harmonic Scalpel with a hook dissector. A CO2 insufflation technique with 8-10 mmHg of intrathoracic pressure safely improved visualization of the IMA in each case. The mean operative time was 65 minutes (range 45-95) for the left and 35 minutes (range 25-45) for the right. All the pedicled IMAs but one which was lost due to intimal dissection had satisfactory free flows. Video-assisted mammary harvest can be accomplished with insufflation technique and facilitated by using the Harmonic Scalpel with a hook dissector.
我们研发了一种使用超声刀的电视辅助乳腺摘取技术。在此报告其临床方法及结果。自1995年11月起，通过胸腔镜摘取了70条左乳内动脉和5条右乳内动脉（L/RIMA），并用于微创冠状动脉搭桥术。每条乳内动脉均摘取至第一肋上缘或更高位置以及分叉处。仅使用带有钩形剥离器的超声刀进行分支的凝固和切割，止血效果良好。采用8 - 10 mmHg胸内压的二氧化碳充气技术，在每种情况下均能安全改善乳内动脉的视野。左乳内动脉摘取的平均手术时间为65分钟（范围45 - 95分钟），右乳内动脉摘取的平均手术时间为35分钟（范围25 - 45分钟）。除一条因内膜剥离而丢失外，所有带蒂乳内动脉的血流均令人满意。电视辅助乳腺摘取可通过充气技术完成，使用带有钩形剥离器的超声刀可使其更便利。
