Endoscope-Assisted Minimally Invasive Surgery for Coronary Artery Bypass

Objective: Cardiac surgeons began in this decade to apply the endoscopes in their practices. Endoscopic graft harvest for coronary artery bypass surgery (CABG) has become the routine practice in many institutes. However, endoscopic harvest of the left internal mammary artery (LIMA) has remained a technical challenge. Methods: From April 2002 to April 2004, 40 patients underwent minimally invasive direct CABG using LIMA to left anterior descending (LAD) artery bypass. Twentyone of them had endoscopic harvest of LIMA. Results: There was neither early nor late operative mortality. Endoscopic LIMA harvest time ranged from 38 to 125 minutes (mean 56 minutes). All harvested LIMAs had a burst flow while being cut from the distal end. The length of thoracotomy was 5 to 8 cm (mean 6.2 cm).Ten patients were extubated immediately. One patient had hemothorax which required chest tube insertion. The intensive care unit (ICU) ventilation time was 0 to 40 hours (mean 7 hours). The ICU stay and hospital stay were 1.3±0.3 and 6.2±1.5 days, respectively. Conclusions: Endoscope-assisted LIMA harvest is a feasible technique. The learning curve, however, shows that this approach reduces wound length, recovery time, and helps extend the graft length to facilitate the anastomosis. It provides patients with an alternative choice to have a satisfactory conduit in a minimally invasive way.