The use of LigaSure for preservation of a previous coronary artery bypass graft by using the left internal thoracic artery in a left upper lobectomy.

In a 63-year-old man, an opacity localized in the left upper pulmonary lobe was incidentally discovered on chest radiographic analysis. He had undergone CABG 8 years before with the LITA on the left anterior descending coronary artery. Clinical and laboratory evaluation showed no abnormalities. Spirometric results were normal. Computed tomographic analysis demonstrated a peripheral mass in the left upper lobe, and there was no significant mediastinal adenopathy. Bronchoscopy did not demonstrate abnormalities of the left upper bronchus, and percutaneous needle biopsy showed a non–small cell lung cancer (NSCLC). A standard posterolateral thoracotomy incision was performed through the fifth intercostal space. A 6-cm tumor was found in the left upper lobe (Figure 1). The dissection of the lobe from the pericardium was possible, but dense adhesions were identified between the LITA and the apex of the upper lobe. The challenge was to do an upper lobectomy while avoiding injury to the LITA. Therefore the part of parenchyma adjacent to the LITA was separated from the upper lobe by using LigaSure system (Figure 2). After this maneuver, we performed an anatomic upper lobectomy, leaving a small strip of parenchyma adjacent to the LITA; we tested the arterial graft manually, and a good pulsation was found. Anatomopathologic studies showed a 6–cm stage IB squamous cell carcinoma, according to TNM classification.2 The patient’s postoperative course was unremarkable, and he was discharged on the seventh postoperative day.