Bi-lateral Internal Thoracic Arteries Harvesting Using Da Vinci Surgical System For Midcab

 

BACKGROUND: We have used da Vinci surgical system for harvesting LITA and/or RITA in our MIDCAB. Even in MIDCAB, we must design pathways of conduits like OPCAB or CABG, in consideration of the quality of coronary artery revascularization. In this presentation, we show simple and safe method of introduction of RITA to the left thorax.

METHODS: 

Both arms were placed on each side of the operation table, so that surface of bilateral thorax were fully exposed.

The camera port was placed in the 4th ICS above the anterior axillar line, and the two arm-ports were place in the 2nd and 6th ICS above the mid-claviluara line.

At first, LITA was harvested by complete skeletonized fashion by da Vinci system. Before moving to the right side, pericardium was opened to make sure the length was long enough for the target of LAD. Then, da Vinci system was un-docked, the arm was rotated to the right side. We docked the system again, and started for RITA as same as the left side.

RITA was harvested as long as possible. 

After heparinization, the distal site of RITA was transected by placing a clip ligated with a 2-0 silk string on the distal end. After harvesting of both ITAs, we prepared an 8-mm Nelaton catheter of the length of 10cm. In the right thorax, pericardium was opened near the aorta and SVC with da Vinci system, to confirm a passing way toward the transverse sinus. The round tip of the Nelaton catheter was introduced in a halfway, then, RITA and Nelaton catheter were connected together. From the left thoracotomy, we could find the tip of the Nelaton catheter, to pull it gently to get RITA. Free flow from RITA should be confirmed to make sure any injury and torsion of RITA.