Endoscopic Radial Artery Harvesting for CABG

This video presents a case of endoscopic radial artery harvesting using a reusable retractor with an open CO2 insufflation system. The procedure was performed with the patient’s arm positioned at a 90-degree angle from the body and a tourniquet was applied to the shoulder for controlled blood flow occlusion. A 1.5-2.5 cm longitudinal incision was made proximal to the wrist to expose the radial artery (RA) under direct vision. Tight bandaging and inflation of the tourniquet to 250 mmHg optimized hemostasis and visualization during the endoscopic procedure. 
 
The harvesting was conducted using a reusable endoscopic radial artery retractor and the LigaSure system, which created a working tunnel in the subcutaneous tissue to facilitate retractor movement. The RA, along with its venae comitantes and surrounding tissue, was harvested in a pedicled fashion. At the conclusion of the procedure, the distal radial artery was ligated, and the proximal artery was secured using an endoloop to avoid additional incisions. 
 
After the radial artery was removed, the tourniquet pressure was gradually released, and hemostasis was confirmed. The wound was closed with a skin suture and was tightly bandaged. The harvested artery was stored in a papaverine and verapamil solution for later use in coronary artery grafting. Postoperative recovery was documented, showing the condition of the hand on the third postoperative day. 
 
This technique demonstrates the effectiveness and precision of endoscopic radial artery harvesting using reusable instruments and an open CO2 insufflation system.  

References

1. Ferdinand FD, MacDonald JK, Balkhy HH, et al. Endoscopic Conduit Harvest in Coronary Artery Bypass Grafting Surgery: An ISMICS Systematic Review and Consensus Conference Statements. Innovations. 2017;12(5):301-319. doi:10.1097/imi.0000000000000410

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