Robotic-Assisted Left Internal Mammary Harvest With the Robotic Harmonic Scalpel​

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Robotic-assisted mammary dissection is routinely performed using either monopolar or bipolar electrocautery, which confers the risk of thermal injury to the mammary artery and often necessitates frequent instrument changes to allow clip application. In pursuit of an optimal harvest technique, the authors present a method that utilizes the robotic harmonic shear as a scalpel for mammary artery dissection.  

The robotic-assisted minimally invasive direct coronary artery bypass (MIDCAB) operation was performed in the standard manner, utilizing standard port placement as previously presented. After opening the lateral endothoracic fascia, the monopolar cautery in arm 4 was exchanged for the robotic harmonic shear, and the left internal mammary artery was primarily harvested with this energy source.  

The patient successfully underwent robotic-assisted left internal mammary artery harvesting, with harmonic energy used for both dissection and hemostasis for the majority of the mammary artery’s length, as demonstrated in the video. The total robotic time was approximately 55 minutes, with harmonic scalpel utilization for 30 to 35 minutes. The nonjointed robotic harmonic shear can be utilized for safe internal mammary artery harvest during robotic-assisted MIDCAB. 

Disclosure 

A. Luckert serves as a consultant for Intuitive Surgical Solutions. D. Brinster holds consulting roles with Cook Medical, Terumo Aortic, and W.L. Gore & Associates. N.C. Patel is a consultant for Intuitive Surgical Solutions and is also on the advisory board for Vascular Graft Solutions.  

References

1. Lamm P, Juchem G, Weyrich P, Schütz A, Reichart B. The harmonic scalpel: optimizing the quality of mammary artery bypass grafts. Ann Thorac Surg. 2000 Jun;69(6):1833-5. doi: 10.1016/s0003-4975(00)01288-1. PMID: 10892932​
2. Newman, Joshua S., Daniel Lambert, Stevan S. Pupovac, & Nirav C. Patel. “How to robotically take down a mammary artery.”
   Annals of Cardiothoracic Surgery [Online], 13.5 (2024): 455-457. Web. 13 May. 2025​
3. Ohtsuka, Toshiya, et al. “Thoracoscopic internal mammary artery harvest for MICABG using the harmonic scalpel.” The Annals of Thoracic Surgery, vol. 63, no. 6, June 1997, https://doi.org/10.1016/s0003-4975(97)00292-0.

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