Sternum Lifting Technique For Thoracoscopic Internal Thoracic Artery Harvesting
Toshiya Ohtsuka, Mikio Ninomiya, Taisei Maemura.
Cardiovascular Surgery, Tokyo Metropolitan Fuchu General Hospital, Tokyo, Japan.
OBJECTIVE: Since Aug. 1997, we have experienced 207 cases of thoracoscopic internal thoracic artery (ITA) immobilization. In the last twelve patients, we developed the sternum lifting technique to create an intra-pleural working space, which was an alternative method to the carbon dioxide insufflation technique. We present the clinical outcome of this method.
METHODS: Each patient was placed in the 20-degree right recumbent position and the left hemi-pulmonary collapse was achieved with a double-lumen endotracheal tube. Sternum lifting was implemented employing the Laparolift (Origin Medsystems, Inc., CA, USA), which was fixed at the operating table. The Laparofan (Figure, left top) was connected with the extendable arm of the lift machine which was electrically movable up and down, the closed fan was introduced underneath the sternum through a subxyphoidal mini-incision, the fan was opened, and the connected arm was moved upward (about 5cm high) to elevate the sternum (Figure).
RESULTS: In all twelve patients, the left ITA was taken down thoracoscopically, and a sufficient working place was created between the heart and the anterior chest wall using the present technique. The harvesting time was 38±7.5 minutes, and no deaths or procedure-related morbidities occurred. Patency of each graft was angiographically confirmed.
CONCLUSION: Although our experience is limited, the present technique is viable for thoracoscopic ITA harvesting and can be an alternative to the CO2 insufflation technique. 