OPERATIVE OUTCOMES OF MINIMALLY INVASIVE SAPHENOUS-VEIN HARVEST

BACKGROUND: The longest incision used in surgery is the standard incis ion for harvesting the greater saphenous Vein for arterial grafting. T his long incision is associated with significant pain and morbidity. W e present a comparative study between two relatively less invasive tec hniques: the standard bridge technique (BT) and the endoscopic sapheno us Vein harvest (ESVH). PATIENTS AND METHODS: This is a prospective, n on-randomized, case-matched study of contemporaneous minimally invasiv e saphenous vein harvest in patients undergoing multiple vessel corona ry artery bypass grafting (CABG), Data points include operative time, total wound length, length of vein harvested, intraoperative complicat ions, conversions to open, injury to the graft, postoperative complica tions and hospital length of stay. Follow-up continued for 8 weeks pos tdischarge. RESULTS: Within a 10-month period (July 1996 to May 1997), 60 saphenous vein harvests were performed, with 29 by BT and 31 by ES VH. Patient demographics were well matched, except for a larger number of patients with peripheral Vascular disease in the ESVH group. ESVH only required 2.3 incisions versus 5 for the BT (P = 0.000001), wherea s ESVH produced on average longer veins of 53.9 cm versus 47.7 cm for BT (P = 0.05), Harvest times were comparable in the two groups. Howeve r, mean vein preparation times, incision closure times, and total vein operative times for the BT were, respectively, 18.5 minutes, 35.1 min utes, and 94 minutes versus significantly less times of 11.3 minutes ( P = 0.009), 10.6 minutes (P = 0.000001), and 73 minutes (P = 0.0001), respectively, for ESVH. The early, minor wound complication rate was 3 2% for the ESVH group versus 3% for the BT group (P = 0.0048). However , excluding small wound hematomas, the wound complication rate in the ESVH group fell to 13%. Graft quality was acceptable in both groups. C ONCLUSIONS: ESVH was demonstrated to be a useful procedure to harvest saphenous veins for CABG surgery, The ESVH technique allowed the harve sting of a longer vein, via shorter and fewer incisions and in less ti me. However, for maximum operating room efficiency with the new techno logy, staff education is essential. There was a greater incidence of m inor wound complications in the ESVH group; however, the majority of t hese ESVH complications were small wound hematomas, which did not occu r as surgeon experience with the technique increased. (C) 1998 by Exce rpta Medica, Inc.