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Comparison of the effect of monopolar and bipolar cauterization on skeletonized, dissected internal thoracic arteries
1Hope Heart Institute, University of Washington School of Medicine, Seattle, USA.
Insights
Bipolar cauterization offers superior branch closure and less endothelial damage compared to monopolar cauterization for skeletonized internal thoracic artery dissection in coronary artery bypass grafting.
Area of Science:
- Cardiovascular Surgery
- Surgical Techniques
- Vascular Biology
Background:
- The internal thoracic artery is a preferred conduit for coronary artery bypass grafting (CABG).
- Skeletonization of the internal thoracic artery enhances its length and applicability.
- Cauterization is commonly used for branch division during skeletonization.
Purpose of the Study:
- To compare the effectiveness and local effects of bipolar versus monopolar cauterization for dividing branches of the canine internal thoracic artery during skeletonized dissection.
Main Methods:
- Branches of canine internal thoracic arteries were divided using either bipolar or monopolar cauterization.
- Branch closure security was assessed by monitoring for bleeding.
- Leakage was evaluated under increased luminal pressure.
- Endothelial cell integrity was examined using scanning electron microscopy.
Main Results:
- Bipolar cauterization resulted in significantly less bleeding (1.3%) compared to monopolar cauterization (9%).
- Monopolar cauterization showed a higher prevalence of leakage under increased pressure.
- Scanning electron microscopy revealed less endothelial cell damage with bipolar cauterization versus monopolar cauterization, especially after secondary treatment.
Conclusions:
- Bipolar cauterization is more effective and causes less collateral damage than monopolar cauterization for skeletonized internal thoracic artery dissection.
- These findings support the preference for bipolar cauterization in CABG procedures utilizing skeletonized internal thoracic artery grafts.
Abstract:
The internal thoracic artery is preferable to the saphenous vein for use as a conduit for coronary artery bypass. More extensive use is possible if this artery is mobilized in a skeletonized form to provide greater length. Internal thoracic arteries are usually mobilized with cauterization. This study compared the effectiveness and effects on neighboring areas of division of the branches of the canine internal thoracic artery with bipolar cauterization and monopolar cauterization. Branch closure was significantly more secure in the bipolar cauterization group, with bleeding in 25 (9%) of 279 branches of 15 internal thoracic arteries treated with monopolar cauterization, in contrast to bleeding in 4 (1.3%) of 306 branches in the 15 internal thoracic arteries treated with bipolar cauterization, which were paired with the group treated with monopolar cauterization. The group of internal thoracic arteries treated with monopolar cauterization had a significantly higher prevalence of leakage when luminal pressure was increased from 120 to 160 mm Hg. Scanning electron microscopy demonstrated partial loss of endothelial cells on the flow surface of internal thoracic arteries treated with bipolar cauterization, compared with almost complete loss of endothelial cells around the orificial areas after monopolar cauterization. Secondary bipolar cauterization treatment caused only slightly more damage than primary treatment, but secondary monopolar cauterization was much more severe and extensive than primary treatment. These data suggest that bipolar cauterization is preferable to monopolar cauterization for skeletonized dissection of the internal thoracic artery.