Ambidextrous techniques in cardiac surgery.

Ambidexterity is the state of being equally adept in the use of both the left and right hands. It is advantageous in surgeons, but the degree of ambidexterity found among them varies greatly. It is a very desirable attribute in laparoscopic surgery. It provides the surgeon with additional options for performing critical surgical steps when positioning and space are constrained, as is often the case in cardiac surgery and even more so in minimally invasive cardiac surgery. Mentoring for ambidexterity training can be initiated as early as during medical school.  In this tutorial we demonstrate ambidextrous surgical techniques such as the 'all in one hand' technique of using two forceps in one hand, Gilbert's technique of left internal mammary harvest, and a proximal anastomosis technique in aortocoronary bypass.

Modified carbodissection: A new technique for harvesting the internal mammary artery.

The modified carbodissection technique is a new technique for harvesting the internal mammary artery during coronary artery bypass graft surgery. It is performed using an improvised instrument that consists of an electrocautery device and a carbon dioxide blower/mister. It combines electrocautery dissection and continuous controlled gas blow dissection along with saline irrigation mist. Gas dissection causes vasodilation and maintains the artery in a dilated state during dissection. Saline flow reduces the amount of heat generated at the cautery site and prevents drying and desiccation of the tissues. This technique is safe in terms of reduced thermal injury, and reduced early arterial spasm and myocardial ischemia, and it improves vision during harvest and shortens the duration of the harvesting procedure.