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Ann Thorac Surg 2000;69:1643-1644
© 2000 The Society of Thoracic Surgeons

Correspondence

Harmonic scalpel: a word of caution

Sachin Talwar, MSa, Anil Bhan, MCha, Rajesh Sharma, MCha, Panangipalli Venugopal, MCha

a Department of Cardiothoracic and Vascular Surgery, All India Institute of Medical Sciences, Ansari Nagar, New Delhi-110029, India,

e-mail: anil_bhan{at}hotmail.com

To the Editor

The harmonic scalpel (Ethicon Endosurgery, Cincinnati, OH) has been increasingly used to harvest arterial conduits in patients undergoing coronary artery bypass grafting [1, 2]. Its advantages over electrocautery have been cited as being faster harvesting of the conduit and having less clip requirements, less intraoperative blood loss, less postoperative blood loss leading to a lower reexploration rate, and less peripheral neuropathies in patients in whom the radial artery is harvested [1, 2].

The mechanism of action is collagen denaturation in tissues caused by ultrasound mechanical motion of the tip of the instrument, which is transmitted to the tissues. The coagulum so formed because of denaturation of collagen is hemostatic. We have observed that this white coagulum formed around the branches of the artery sometimes moves into the lumen of the conduit. We have recovered this white coagulum from the internal mammary artery when it was allowed to bleed freely. In the case of the radial artery, it was recovered after flushing of the artery with papaverine solution.

Therefore, when these conduits are harvested using the harmonic scalpel, this coagulum must be completely removed to avoid embolization of the coronary circulation during coronary artery bypass grafting. For this, the internal mammary artery should be allowed to bleed freely, and the radial artery should be flushed until free of the coagulum.

References

  1. Tanemoto K., Kanaoka Y., Murakami T., Kuroki K. Harmonic scalpel in coronary artery bypass surgery. J Cardiovasc Surg (Torino) 1998;39:493-495.[Medline]
  2. Isomura T., Suma H., Sato T., Horii T. Use of the harmonic scalpel for harvesting arterial conduits in coronary artery bypass. Eur J Cardiothorac Surg 1998;14:101-103.[Abstract/Free Full Text]




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