Ann Thorac Surg 2004;77:1135
© 2004 The Society of Thoracic Surgeons
Correspondence
A word of caution about the skeletonization of the right gastroepiploic artery: Reply
Tohru Asai, MD
Division of Cardiovascular Surgery, Department of Surgery, Shiga University of Medical Science, Seta-tsukinowacho, Ohtsu, Shiga 520-2192, Japan
e-mail: toruasai{at}belle.shiga-med.ac.jp
To the Editor:
I thank Dr Osawa and his associate for their interest in our article [1]. Until we developed our method of skeletonizing the right gastroepiploic artery (GEA), we tried low-energy electrocautery, an ultrasonic scalpel with a dissecting hook, and conventional scissors and clips. We found that arterial and venous branches and associate veins often were extremely fragile and prone to bleed, which makes the GEA different from other arterial conduits. Compared with other methods, the Harmonic Scalpel with coagulating shears was most effective in preventing bleeding, even in thick omenta.
We sometimes have encountered very thick omenta but have never experienced the technical limitation pointed out by Osawa and Matsuyama. As described in our article, while gently pulling up the vessel loops encircling the conduit, we could inspect the GEA trunk and divide surrounding tissues safely and hemostatically no matter how thick the omentum was. It is crucial to identify the location of the GEA prior to dividing the branches. The fat in the omentum can be removed easily with the Harmonic Scalpel. If done properly, this method is safe for use in most omenta.
References
- Asai T., Tabata S. Skeletonization of the right gastroepiploic artery using an ultrasonic scalpel. Ann Thorac Surg 2002;74:1715-1717.[Abstract/Free Full Text]
