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Modified Octopus Technique for Thoracoabdominal Aortic Aneurysm

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Endoscopic Internal Thoracic Artery Harvesting with Changes in Scope Position.

Goto Yoshihiro¹, Sho Takagi¹, Junji Yanagisawa¹

¹Department of Cardiovascular Surgery, Toyohashi Heart Center, Toyohashi, Japan.

The Heart Surgery Forum

|December 28, 2021

Summary

Minimally invasive direct coronary artery bypass (MIDCAB) surgery is challenging due to difficult internal thoracic artery (ITA) harvesting. This study presents a novel 3D endoscopic technique for improved ITA harvesting during MIDCAB procedures.

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Area of Science:

Cardiovascular Surgery
Minimally Invasive Techniques
Endoscopic Surgery

Background:

Minimally invasive direct coronary artery bypass (MIDCAB) offers a less invasive approach for coronary revascularization.
Harvesting the internal thoracic artery (ITA) remains a technical challenge in MIDCAB procedures, potentially limiting its widespread adoption.

Observation:

A novel technique for ITA harvesting was developed using three-dimensional (3D) endoscopy without robotic assistance.
Enhanced computed tomography (CT) was utilized to precisely determine the endoscope's position during the procedure.
The surgical approach involved adaptable camera port placement and a skeletonized harvesting technique with a harmonic scalpel.

Findings:

The 3D endoscopic approach facilitated successful ITA harvesting in a patient undergoing MIDCAB for recurrent in-stent restenosis.
The ITA was harvested from the level of the subclavian vein superiorly to the xyphoid process inferiorly.
This method allowed for precise visualization and dissection, overcoming harvesting difficulties.

Implications:

This technique may enhance the feasibility and safety of MIDCAB procedures by simplifying ITA harvesting.
Adoption of 3D endoscopy could improve surgical outcomes and reduce complications associated with traditional ITA harvesting.
Further research is warranted to evaluate the long-term efficacy and broader applicability of this endoscopic harvesting method.