Harvest of the right gastroepiploic artery graft using a novel hybrid ultrasonic/bipolar energy device

Abstract

Background: The right gastroepiploic artery (RGEA) is a useful in-situ graft, and skeletonization is effective to prevent spasm and achieve good patency. To harvest the skeletonized RGEA easily, ultrasonic scalpel has been widely used, but the tip shape of conventional ultrasonic device was not optimal for this procedure.Recently, a novel hybrid ultrasonic/bipolar energy device (THUNDERBEAT Open Fine Jaw [TOFJ]) has been developed and is widely used in general surgery.Surgical Technique: The operator holds forceps in left hand and TOFJ in right hand, incises the anterior layer of the omentum, and extends the incision distally along the RGEA. The side branches and satellite veins were sealed and cut. Because the tip of the TOFJ is well-designed to easily grasp and peel off the tissue, there is no need to change instruments throughout the procedure. After the dissection was advanced distally, the proximal side was subsequently dissected.Conclusions: This novel device is useful for harvesting skeletonized RGEA. K E Y W O R D S coronary artery bypass grafting, gastroepiploic artery, harvesting technique, hybrid ultrasonic/bipolar energy device, THUNDERBEAT