Skeletonized internal thoracic artery harvesting using the Harmonic Focus ultrasonic scalpel

The hook-type blade of Harmonic ultrasonic scalpel has conventionally been used for skeletonized harvesting of the internal thoracic artery (ITA) graft in coronary artery bypass grafting. However, supply of the blade became unstable for a period of time. During the period, another harvesting technique was necessary. Herein, we present a new skeletonized ITA graft harvesting technique using the shear-type blade of Harmonic ultrasonic scalpel. The Harmonic Focus^TM+ (HF) has a shear-type blade. The closed-shear mode is used for blunt dissection of surrounding fat tissue. The open-shear mode is useful for precise lesion dissection. The vessel branch can be sealed and cut by clamping the branch between the tissue pad and blade. Thirty-one patients who underwent coronary artery bypass during this study period received an ITA graft harvested using the shear-type blade of Harmonic ultrasonic scalpel. In the studied cases, all ITA grafts were used as vascular grafts without injuries, and no cases required a change to another harvesting technique. After this harvesting technique was established, the harvesting time was 15-30 minutes. The mean flow of ITA grafts after revascularization was 45.3±22.1 mL/minute. There were no complications related to this harvesting technique. A skeletonized ITA can be harvested easily and safely using the HF ultrasonic scalpel. Although ITA harvesting using a hook-type blade Harmonic ultrasonic scalpel is common and widespread, this harvesting technique can be a useful alternative when other devices are unavailable.