[Video-assisted mammary harvest technique with harmonic scalpel]

We have developed a video-assisted mammary harvest technique using the Harmonic Scalpel. The clinical method and results are reported here. Since Nov. 1995, 70 left and 5 right internal mammary arteries (L/RIMAs) were taken down thoracoscopically and utilized for minimally invasive coronary artery bypass grafting. Each of the IMAs was harvested up to the upper margin of the first rib or higher and down to the bifurcation. Coagulation and cutting of the branches were achieved with excellent hemostasis using only the Harmonic Scalpel with a hook dissector. A CO2 insufflation technique with 8-10 mmHg of intrathoracic pressure safely improved visualization of the IMA in each case. The mean operative time was 65 minutes (range 45-95) for the left and 35 minutes (range 25-45) for the right. All the pedicled IMAs but one which was lost due to intimal dissection had satisfactory free flows. Video-assisted mammary harvest can be accomplished with insufflation technique and facilitated by using the Harmonic Scalpel with a hook dissector.