This prospective, randomized study was carried
out in the Department of Cardiovascular Surgery,
Acibadem Altunizade Hospital between January 2019 and September 2019. Patients with more than
90% stenosis of the coronary artery and those who
were scheduled for CABG were screened. A total of
53 patients (44 males, 9 females; mean age: 63.7±8.4
years; range, 39 to 83 years) who underwent CABG
for RA harvesting with electrocautery or LigaSure™
vessel sealing system were included. Both techniques
were described in detail to all participants before
the operation. A written informed consent was
obtained from each patient. The study protocol was
approved by the Acibadem Mehmet Ali Aydınlar
University, Ethics Committee (Date: 21/03/2019;
No: 2019/6-30). The study was conducted in
accordance with the principles of the Declaration
of Helsinki. The Allen test was performed to all
patients. The patient’s left arm was supinated and
pulse oximeter was placed on the index finger of the
left hand. Radial and ulnar arteries were palpated,
and both were compressed until the pulse oximeter
trace was present. Afterwards, the ulnar artery was
released, and seconds were counted until the trace
was fully returned. A positive result was considered
between 3 and 5 sec, indicating a patent ulnar artery.
The patients with a positive Allen test result were
enrolled. By using a computer-generated random
list, all patients were randomized into two groups.
Group 1 consisted of 26 patients operated with the
LigaSure™ (Medtronic, Minneapolis, MN, USA)
small jaw sealer/divider (LF1212A) for RA harvesting
during open CABG surgery and Group 2 consisted of
27 patients operated with low-energy electrocautery
(Erbe Elektromedizin GmbH, Tübingen, Germany).
Electrocautery is a device used for hemostasis and
tissue dissection using direct or alternative current
to generate heat. The LigaSure™ small jaw is a
vessel-sealing device that uses both electrothermal
energy and pressure.[
4]
The lengths of the harvested RAs, duration of
the harvest, amount of blood loss from the beginning
of harvesting to the end of the closure of the skin
of the left arm, number of hemostatic clips before
and after the anastomosis of RA to coronary artery,
amount of blood loss postoperatively, presence of
ecchymoses, hematoma and infection were compared.
The length of the RA was measured in cm. The
amount of blood loss per operatively was measured
by the number of gauzes used for left arm, and one
gauze was estimated to absorb 10 mL. The amount
of blood loss postoperatively was evaluated by the mL
of blood collected in the drainage bag. Ecchymoses, hematoma, and paresthesia were documented as the
absence or presence, 1 and 0, respectively. The length
of the conduits was measured in cm. The duration of
the harvest of the left RA was considered to be from
the first incision of the left forearm to the freeing of
the conduit. Data including age, sex, and body surface
area (BSA) were recorded.
Subcutaneous tissue and fascia were dissected with
the LigaSure™ curved, small jaw, open sealer /divider
after the cutaneous incision in Group 1. Although the
dissections were done mainly with the LigaSure™,
some of the thin branches were dissected with scissors.
The branches were freed from the RA at the distance
of 2 mm with the LigaSure™. After the dissection
was done, RA was ligated distally. Branches were
clamped with bulldog clamps and the bleeding was
checked. Branches larger than 5 mm were clipped.
After the proximal and distal anastomosis were done,
the branches were controlled and bleeding branches
were clipped.
Once the incision was done along the length of
the RA, subcutaneous tissue and fascia were dissected
with electrocautery in Group 2. The branches of RA
were dissected with scissors along the length. All
branches were clipped with small titanium hemoclips
(Horizon™ ligating clips; Weck-Teleflex, North
Carolina, USA), and tissue side was tied with 4.0 silk.
After the dissection was done, the RA was cut distally
and clamped with bulldog clamps. The branches were
checked by the antegrade flow. Leaking branches were
clipped. After the proximal and distal anastomosis
were done, the branches of the artery were controlled
and clipped.
Statistical analysis
Statistical analysis was performed using the SPSS
version 9 software (SPSS Inc., Chicago, IL, USA). Continuous variables were expressed in mean ± standard
deviation (SD) or median (interquartile range [IQR]),
while categorical variables were expressed in number
and frequency. Continuous variables were compared
using the Student’s unpaired t-test. Categorical
variables were compared using the chi-square test. A p
value of <0.05 was considered statistically significant.
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