Shi-Min Yuan*


The effects of internal mammary artery (IMA) harvest by harmonic scalpel under conventional open, thorascopic, and robotic coronary artery bypass have not been sufficiently evaluated. The study materials were based on literature retrieval of pertinent articles published between 1998 and 2018. In total 20 articles describing IMA harvest for 2,661 patients was accomplished by the harmonic scalpel in open, video-assisted or robotic CABG procedures (termed as the innovative group), while IMA harvest by electrocautery and (or) argon beam coagulator were taken as the control group. It revealed that IMA harvest by harmonic scalpel was associated with less thermal injury with potentially better preservation of the endothelial cells, satisfactory intraoperative IMA flow, and promising postoperative IMA patency. Apart from the harvest-related merits, the innovative techniques had other advantages in terms of clinical outcomes, such as lower postoperative mortality and complications. Nevertheless, concerning the disadvantages of thorascopic and robotic IMA harvesting, such as longer harvest time, prolonged operative time, and increased hospitalization expenses, they could be used in selected and non-emergent pateints with coronary artery disease.



Coronary artery bypass grafting, internal mammary artery, surgical instruments, robotics, video-assisted surgery.