Overcoming First Rib Obstruction During Left Internal Thoracic Artery Harvesting in Minimally Invasive-Coronary Artery Bypass Grafting: A Practical Approach Using Ultrasonic Bone Sculpting

Harvesting the left internal thoracic artery (LITA) during minimally invasive coronary artery bypass grafting (MICS-CABG) can be technically demanding, particularly in patients with a prominent osteophyte at the first costochondral joint. We report the use of an ultrasonic aspirator system, the SONOPET iQ (Stryker), to facilitate safe and effective LITA harvesting in such anatomically challenging cases. The SONOPET iQ was employed when proximal LITA exposure was hindered by the protrusion of the first rib at the costochondral junction. Operating at an ultrasonic frequency of 25 kHz, the device enabled precise bone sculpting with minimal heat generation and bleeding-an essential advantage within the constrained operative field of MICS-CABG. By allowing controlled thinning of the first rib, the SONOPET iQ enhanced visualization and access to the LITA without requiring extensive rib retraction or resection. This adjunctive technique improves surgical safety and exposure by enabling accurate bone modification while minimizing thermal injury and bleeding. The SONOPET iQ offers a simple, reproducible, and effective solution for overcoming anatomical obstacles during LITA harvesting in MICS-CABG.