PURPOSE: The Enseal device(SurgRx, Palo Alto, CA), a novel nanoscale-controlled bipolar radiofrequency instrument, has been recently introduced in the surgical armamentarium as a vessel sealing system, albeit to date its use was restricted to settings other than cardiovascular surgery. We therefore aimed to assess the feasibility and safety of endoscopic radial artery harvesting(ERAH) with this novel tool.
METHODS: Sixteen patients scheduled for coronary surgery underwent ERAH combining the Enseal device with a reusable retractor(Endovein retractor, Karl Storz, Germany): the Enseal is a 5 mm large, 35 cm long grasper; it allows adjustment of tissue-dynamic energy delivery at the electrode-tissue interface according to the specific tissutal impedance. A 2 cm incision is performed at the wrist crease; endoscopic dissection around the radial artery is carried out just by means of the Enseal; finally, a 1.5 cm counterincision is performed near the antecubital space. After fixation with 6% neutral formalin, paraffin embedding was used for histology. Five micron sections were stained by means of haematoxylin-eosin, Masson trichrome and acid orcein. A semiquantitative 0- to 4-point scale was used for histology.
RESULTS: ERAH was successfully performed in all patients(mean harvesting time: 33±7 minutes); no bleeding was observed from the sealed side branches. No complications requiring conversion to the open technique occurred. No considerable charring or sticking were macroscopically evident. At histology, endothelial loss was 0.9±0.7, loss of internal lamina elastica was 0.5±0.8, advential hemorrhage was 0.5±0.5, vasa vasorum heat associated damage and margination of white blood cells were 0.1±0.5 and 0.2±0.5 respectively. No hand neurological impairment, vascular compromise or haematoma were reported.
CONCLUSION: ERAH combining the Enseal system and a reusable retractor is a feasible procedure. The Enseal device proved to be safe and effective with negligible damage to the harvested conduits at histological analysis.
CLINICAL IMPLICATIONS: This novel tool adds to the surgical armamentarium for ERAH, filling a definitive need in the field of minimally invasive conduit harvesting.
DISCLOSURE: Gianluigi Bisleri, None.