Comparison of Sharp Dissection, Electrocautery, and Ultrasonic Activated Scalpel with Regard to Endothelial Damage, Preparation Time, and Postoperative Bleeding During Radial Artery Harvesting

Abstract

ObjectiveTo examine the effects of classical technique, electrocautery, and ultrasonic dissection on endothelial integrity, function, and preparation time for harvesting the radial artery (RA) during coronary artery bypass grafting (CABG).MethodsForty-five patients who underwent isolated CABG and whose RA was suitable for use were studied and divided into three groups: Group 1, classical method (using sharp dissection); Group 2, electrocautery; and Group 3, ultrasonic cautery. Levels of prostacyclin and nitric oxide derivatives were examined biochemically; vascular cell adhesion molecule 1 (VCAM-1) and endothelial nitric oxide synthetase (eNOS) values were assessed using immunohistochemical staining. RA preparation time, RA length/harvesting time ratio, and drainage amounts at the site of RA removal were compared.ResultsDifferences in RA preparation time (Group 1: 25±6 min, Group 2: 18±3 min, Group 3: 16±3 min, P<0.001) and length/harvesting time ratio (Group 1: 0.76±0.19 cm/min, Group 2: 0.98±0.16 cm/min, Group 3: 1.13±0.09 cm/min, P<0.001) were statistically significant among the groups. Levels of prostacyclin and nitric oxide derivatives were not statistically significant different, VCAM-1 and eNOS expressions were observed to be similar among the groups, and endothelial damage was detected in only one patient per group.ConclusionUse of ultrasonic cautery during RA preparation considerably reduces the preparation time and postoperative drainage amount. However, the superiority of one method over the others could not be demonstrated when the presence of endothelial damage with both biochemical and histopathological evaluations was considered.

Comparison of electrocautery and LigaSure™ vessel sealing system in radial artery harvesting as coronary artery bypass surgery conduit: A prospective, randomized study

“…[6] It was also reported in another study that preparation for harvesting the RA using electrocautery took more time than using ultrasonic cautery during CABG and the amount of postoperative drainage was significantly lower in the later technique. [7] The LigaSure™ is a relatively new device in CABG surgeries. Although more studies are needed in this context, a study showed lower mean operative time in patients who underwent thyroidectomy using the LigaSure™ rather than conventional clamp tie and electrocautery technique.…”

Use of Radial Artery Grafts for Coronary Artery Bypass Grafting

“…In 1998, Psacioglu et al [Psacioglu 1998] applied an ultrasonic scalpel to improve RA harvesting, avoiding ligation of the vessels and the thermal damage caused by the electric knife, thereby shortening harvesting time and reducing RA spasm. However, no studies have attempted to validate whether these approaches can maintain endothelial cell integrity [Uysal 2019]. Connolly et al [Connolly 2002] applied their endoscopically harvested radial artery harvesting (ERAH) technique in 300 patients, reporting that this minimally invasive technique resulted in a more aesthetic incision while reducing postoperative forearm pain and the probability of wound infection [Tamim 2020].…”

Reply: Circumferential Lipobrachioplasty Is a Safe Procedure

“…[13][14][15][16][17][18][19][20][21][22][23] Few studies have found sharp dissection and electrocautery to be equivalent or consider both sharp and electrocautery dissection to have the same incidence of postoperative seroma. [24][25][26]…”