Overcoming First Rib Obstruction During Left Internal Thoracic Artery Harvesting in Minimally Invasive-Coronary...

Area of Science:

• Cardiovascular Surgery
• Minimally Invasive Surgical Techniques
• Medical Device Technology

Background:

• Harvesting the left internal thoracic artery (LITA) for coronary artery bypass grafting (CABG) can be challenging.
• Anatomical variations, such as prominent osteophytes at the first costochondral joint, can impede LITA access during minimally invasive coronary artery bypass grafting (MICS-CABG).

Purpose of the Study:

• To evaluate the utility of the SONOPET iQ ultrasonic aspirator system for LITA harvesting.
• To assess the safety and efficacy of using the SONOPET iQ to overcome anatomical challenges during MICS-CABG.

Main Methods:

• The SONOPET iQ system was utilized to address difficulties in proximal LITA exposure caused by first rib protrusion.
• The device operated at 25 kHz for precise bone sculpting, minimizing heat and bleeding.
• Controlled thinning of the first rib facilitated LITA visualization and access.

Main Results:

• The SONOPET iQ enabled safe and effective LITA harvesting in anatomically challenging MICS-CABG cases.
• Precise bone sculpting enhanced visualization and access without extensive rib retraction or resection.
• The technique minimized thermal injury and bleeding in the constrained operative field.

Conclusions:

• The SONOPET iQ is a valuable adjunctive tool for overcoming anatomical obstacles during LITA harvesting in MICS-CABG.
• This technique improves surgical safety, exposure, and reproducibility.
• It offers an effective solution for difficult LITA dissections due to bony prominences.