harmonic scalpel: Optimizing the quality of radial artery bypass grafts

ABSTRACT

Development of new antispasmodic agents and minimally traumatic techniques has led to a revival of the use of Radial Artery [RA] in coronary artery bypass surgery. The ultrasonic activated scalpel [Harmonic Scalpel] has been increasingly used in harvesting arterial conduits. We began to use it for RA harvest with the impression that harvest spasm might be less for the new technique In a prospective randomized study, the harmonic scalpel is used to harvest the RA [group H; 21 patients] in comparison with conventional technique using the electrocautery [group C; 20 patients]. Both groups are compared for the harvest time, frequency of spasm, use of hemoclips, free blood flow [immediately after harvesting and after use of topical vasodilator] and incidence for reoperation for bleeding. The use of harmonic scalpel significantly reduced the harvest time, and the need for hemoclips. It also increased significantly the free blood flow from the conduit. It reduced the incidence of spasm [but without statistical significance]. The incidence of reoperation for bleeding was not significantly different between both techniques. Ultrasonic dissection using the harmonic scalpel provides atraumatic, fast, spasm-free RA harvest with minimal use of hemoclips. Long-term patency rates, however, need to be evaluated