ITA Cold Skeletonization: Simplified Step-by-Step Approach

It's really nice to observe the full length ITA hervesting in this technique & much helpful for surgeons.

Nice technique. could you mention your cautery settings please?

Thank you very much for your question. Mainly we use the cold cautery blade for dissection but if we face connective tissue which is hard to dissect or tends to bleed then we use the active cautery using SWIFT COAG with this setting 40 Watt/ Effect 3 using ERBE VIO 300 D Diathermy device.

Nice video. You can do the complete harvesting with the cold cautery blade for dissection and minimal active cautery for coagulation of the side branches at a distance of 5 millimeters with a 15 Watt setting. This is my preferred method. I do not need any clips.

Thank you Dr. Wanner for your comment. Your technique is very nice and saves some time '' Clipping time'', however we think that complete cold technique specially when dealing with side branches preserves the collaterals and perforators from the intercostals to sternum and may decrease the wound complications specially in high risk group.

This looks very neat. My only concern is that you are required to handle the IMA a lot, and this manipulation could be minimised if you open teh fascia slightly medial to the artery, and pull on that for exposure. That is how I harvest a skeletonised IMA. I also do use cautery, as well as clips and scissors for branches.

Great demonstration. Though not shown, extra length is obtained by harvesting to well beneath the Subclavian Vein, often enough for two composite or sequential grafts. I try to sweep the pleura away from the endothoracic fascia, leaving it largely intact. I agree the use of clips, mimimizing cautery and therefore the thermal injury to the sternum. I do BIMA in most patients, every little technique helps to avoid sternal problems.