A novel technique for harvesting the internal thoracic artery: linear harvesting technique using an ultrasonic surgical aspirator

The internal thoracic artery (ITA) is an important graft for coronary artery bypass grafting (CABG). Conventionally, median sternotomy or three thoracoports has been necessary to harvest ITA. We examined a linear skeletonization technique in a porcine model using an ultrasonic surgical aspirator and electrothermal bipolar tissue sealing system via a subxiphoid approach for harvesting ITA grafts. Eight healthy pigs were used for this study. Under general anesthesia, a 2-cm skin incision was made at the subxiphocostal region. After dividing the rectus abdominis muscle, the superior epigastric artery was visualized. An L-shaped retractor was used to create a working space and insert an endoscope. An ultrasonic surgical aspirator was used to dissect the ITA, and then the electrothermal bipolar tissue sealing system was used to coagulate and cut branches. All procedures were performed under endoscopic vision, allowing safe harvest of sufficient vessel length for CABG. Harvest of the ITA required 45.4±10.9 min. Histologically, the dissected ITA was undamaged and not denatured. We have developed a linear ITA skeletonization technique using only one tiny skin incision. This technique increases the effective length of ITA bypass and is less invasive than conventional ITA harvesting.