Endoscopic Harvesting of the Radial Artery

<p>This video presents the endoscopic harvesting of the radial artery using the Getinge Vasoview Hemopro 2 System. It is an easy to learn technique, and it should preferably be trained after mastery of the endoscopic removal of the vena saphena magna to ensure the greatest possible expertise.<br></p><p>The focus should also be on the patient's position, as shown in the video. The patient is in a supine position and is first washed sterilely. Then the patient is covered except for the thorax foil and the sterile washing of the arm, which is located on an arm splint. The arm is circularly sterilized and placed on a sterile cloth. Then the hand is draped and the arm is covered with a U-cloth. Finally, the thorax foil is applied and the process is completed.</p><p>The hand is placed over the head, and the pulse of the radial artery is palpated. An incision is then made over the course of the vessel and prepared. This preparation must be carried out circularly and with both accompanying veins. Wrapping with a vessel loop is helpful. As far as possible, the radial artery must also be prepared proximally using a hook to facilitate access with the endoscope.</p><p>The endoscope can be used on both sides of the arm, depending on whether the surgeon is left- or right-handed. It is inserted with the dissector tip, and the vessel is bluntly and carefully separated from the surrounding tissue, at first only for a few centimeters to allow for the administration of carbon dioxide. This is an excellent way to improve the visualization of the graft and simplify the preparation considerably.</p><p>The vessel and its branches are then gently exposed up to the cubital fossa. Once this is done, the dissector tip is replaced with the coagulation tool. Starting at this point, the brachioradial fascia is divided to generate a larger diameter of the working tunnel. If the camera gets dirty, it has to be cleaned by a short pull out. All side branches are then coagulated and cut at the same time, ensuring a rapid harvesting. For this purpose, a small C-shaped arm of the surgical tool is used, and it is placed as gently as possible around the radial artery so the branches can be better represented. In addition, a possible thermal injury of the graft is ensured against by a heat protection in the concave side of the coagulation tool. For this reason, the concave side of the coagulation tool must always face the vessel during coagulation. This is one of the most important issues to remove the graft without damaging it.</p><p>As soon as all outlets have been severed, an additional incision of a few millimeters is made in the cubital fossa. Using a small clamp, the radial artery is salvaged, ligated, and severed. At the same time as the removal, a Redon drain can be introduced. The ligation and discontinuation is made distally, and the vessel is flushed with a solution of blood, papaverine, and heparin. Finally, the wound is closed with a monofilament suture using the Donati or Allgöwer technique, and the wound is dressed.</p><hr><p><strong>Suggested Reading</strong></p><p>Kiaii BB, Swinamer SA, Fox SA, Stitt L, Quantz MA, Novick RJ. A prospective randomized study of endoscopic versus conventional harvesting of the radial artery. <a href="https://doi.org/10.1097/IMI.0000000000000386"><em>Innovations (Phila)</em>. 2017;12(4):231-238</a>.</p><p>Rahouma M, Kamel M, Benedetto U, et al. Endoscopic versus open radial artery harvesting: a meta-analysis of randomized controlled and propensity matched studies. <a href="https://doi.org/10.1111/jocs.13148"><em>J Card Surg</em>. 2017;32(6):334-341</a>.</p><p>Dr Rustenbach is a clinical consultant for Getinge AB in Sweden.<br></p>