Double Docking Technique for Bilateral Internal Mammary Artery Harvest

The high technical demands, lengthy procurement, and the elevated incidence of sternal wound complications limit the extensive usage of bilateral internal mammary artery grafting. This video proposes the use of a double docking technique to harvest bilateral internal mammary arteries with the assistance of a Da Vinci robot for the purpose of multivessel coronary revascularization. 

The double docking approach incorporates the semi-skeletonization technique to harvest bilateral internal mammary artery grafts. This technique is much simpler for surgeons to adopt than harvesting right internal mammary artery from the left side. The approach allows for the procurement of increased length of the right internal mammary artery graft from its origin to move beyond the bifurcation region. The surgeon can comfortably perform three to four bypass procedures with an available length of the right internal mammary artery graft of approximately 15-18 cm. 

Additionally, the robot-assisted approach offers enhanced vision, precision, control, and dexterity. A widely held misconception is that the harvest of a second arterial conduit would extend the duration of the procedure. With the use of the double docking technique, the right internal mammary artery harvest can be completed within 30 minutes.

References

1. Han Z, Zhang G, Chen S, Liu G, Chen Y. Application of bilateral internal mammary artery with different configurations in coronary artery bypass grafting. J Cardiothorac Surg. 2021;16(1):2. Published 2021 Jan 6. doi:10.1186/s13019-020-01380-z.
2. Zhu Y, Lingala B, Wang H, Woo YJ. Bilateral vs single internal mammary artery grafts for coronary artery bypass in the United States. Ann Thorac Surg. 2021;111(2):629-635. doi:10.1016/j.athoracsur.2020.05.049
3. Pevni D, Mohr R, Kramer A, Paz Y, Nesher N, Ben-Gal Y. Are two internal thoracic grafts better than one? An analysis of 5301 cases. Eur J Cardiothorac Surg. 2019;56(5):935-941. doi:10.1093/ejcts/ezz094.

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