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Ann Thorac Surg 2007;83:1580-1581
© 2007 The Society of Thoracic Surgeons

Correspondence

Endoscopic Radial Artery Harvesting With a Novel Vessel Sealing System

Gianluigi Bisleri, MD, Tomaso Bottio, MD, PhD, Claudio Muneretto, MD

Division of Cardiac Surgery, UDA Cardiochirurgia – Spedali Civili, University of Brescia Medical School, P.le Spedali Civili, 1, Brescia, 25123 Italy

(Email: bislerig{at}gmail.com).

To the Editor:

We read with interest the article from Newman and colleagues [1] about the development of a cost-effective technique for endoscopic radial artery harvesting using a reusable retractor and thermal welding shears.

The concept of combining a disposable vessel sealing system with a reusable retractor for endoscopic view is appealing and cost-effective, and we recently reported a similar experience combining the Storz Endovein retractor (Karl Storz, Tuttlingen, Germany) with a novel disposable, nanoscale controlled bipolar radiofrequency device [2].

Nevertheless, the report by Newman and colleagues [1] raises concerns with respect to the safety of the thermal welding shears used in the present study. First, the histologic analysis of the specimens as reported by the authors does not clearly rule out the potential risk of lateral thermal spread with the Starion (Starion Instruments, Sunnyvale, CA) device during endoscopic harvesting of the radial artery. As previously reported also by other authors [3], a careful pathologic examination should be adopted before the widespread use of a novel system of endoscopic vessel harvesting, including the assessment of measurements as vacuolation of the tunica media, loss of endothelium, margination of white blood cells, loss of the internal elastic lamina, splitting of the internal elastic lamina, thrombosis, adventitial hemorrhage, peri-adventitial hemorrhage, vasa vasorum heat-associated damage, vasa vasorum thrombosis, and vasa vasorum margination of white blood cells.

In addition, the authors did not carry out or at least reported the bursting strength of sealed arteries with the Starion (Starion Instruments), therefore raising another crucial question about the safety of the system.

Moreover, no study has been reported in the references to confirm the safety of the device in the experimental setting or in the clinical setting at all.

Finally, it would be interesting to know whether the authors performed a postoperative evaluation of the endoscopically harvested vessels by means of angiography or noninvasive techniques as multislice computed tomographic scan.


   References
Top
 References
 

  1. Newman RV, Lammle WG, Matz KJ. Cost effective endoscopic radial artery harvesting Ann Thorac Surg 2006;82:353-354.[Abstract/Free Full Text]
  2. Bisleri G, Piccoli P, Hrapkowicz T, Birtan H, Muneretto C. Nanoscale radiofrequency control technology for endoscopic radial artery harvesting: a case report Heart Surg Forum 2006;9:E700-E702.[Medline]
  3. Bolotin G, Scott Jr WW, Austin TC, et al. Robotic skeletonizing of the internal thoracic artery: is it safe? Ann Thorac Surg 2004;77:1262-1265.[Abstract/Free Full Text]




This Article
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Tomaso Bottio
Claudio Muneretto
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