METHOD FOR ENDOSCOPIC ONE-STAGE SEPARATION OF TWO INTERNAL THORACIC ARTERIES WITHOUT STERNOTOMY Russian patent published in 2025 - IPC A61B17/00 

FIELD: medicine.

SUBSTANCE: invention refers to medicine, namely cardiosurgery, and may be used in surgical management of the patients suffering ischemic heart disease accompanying coronary bypass surgery. Patient is laid on roll 5-6 cm high in a projection of the fourth-fifth intercostal space. Right internal thoracic artery (RITA) is separated by installing a thoracophore on the anterior axillary line in a projection of the second-third intercostals space with CO₂ insufflation. Controlled pneumothorax induced by CO₂ is formed. That is followed by inserting second thoracophore 10 mm for the endoscopic chamber along a medial subclavian line in a projection of the fourth-fifth intercostal space. Third triangular thoracoport 5 mm is inserted in the anterior axillary line in a projection of the sixth-seventh intercostal space. ITA is separated by skeletonisation technique; that is followed by exposing a fascia with separating a posterior side of a mammary vein and separating the ITA with using the mammary veins actively for the ITA manipulation. That is followed by separating the RITA along the whole length, administering heparin intravenously, distal portions of the RITA are clipped and cut off. That is combined with a single-stage thoracotomy in the third-fourth intercostal space, and a left internal thoracic artery (LITA) is separated within an accessible visual field through the left thoracotomy. After the LITA and RITA are separated, heparin is introduced intravenously, the distal ITA are clipped and dissected away. Further, to position the separated RITA in the position of the branch of the obtuse margin, a canal is formed to conduct the RITA through the transverse sinus. In a projection of a superior vena cava, clamping is performed from a thoracic approach, under an aorta in a transverse sinus; after a pericardial incision, the RITA is clamped by an ITA end behind the clipped portion; that is followed by a coronary artery bypass on the working heart with no artificial circulation.

EFFECT: method allows to reduce time of operation and to reduce operative injures with early rehabilitation; besides, the presented method eliminates a risk of breast infection.

1 cl, 1 ex