VIDEO-SURGERY DISSECTION OF THE SAPHENOUS -VEIN FOR CORONARY-ARTERY BYPASS

OBJECTIVES: Saphenous grafts used for coronary artery bypass are class ically dissected via a continuous incision of the leg, the thigh or bo th. Recently, a new video-surgery technique has been introduced in an attempt to reduce the trauma of saphenous vein dissection. Ti-ie aim o f this work was to evaluate the possible benefits of this new techniqu e compared with classical dissection. PATIENTS AND METHODS: Sixty pati ents requiring coronary artery bypass grafts were included in this stu dy and randomly divided into two groups. in group 1 (30 patients) the saphenous vein was dissected according to the classical technique. The video-surgery technique was used iol the other 30 patients in group I I The two groups were not significantly different for mean age, sex ra tio, or history of diabetes or lower limb arteriopathy. The same numbe r of bypasses was performed in both groups (2.6 +/- 0.7). Outcome was compared for: dissection related complications (hematomas, infections) , length of the skin incision over the length of the dissected vein, d uration of the dissection procedure, and post-operative pain. RESULTS: A leg incision was used in 28 cases out of 30 cases in both groups. T he length of the saphenous vein dissected was 27.6 cm in group I and 2 1.8 cm in group II. The length of the skin incision was 27 cm in group I and only 4.7 cm in the video-surgery group II, giving an incision/v ein ratio of 97% and 21% respectively. Operative time was however 37.9 min for group I and 48.5 min for group II. There was no significant d ifference between the groups for hematoma formation or infection bur t he patients in the video-surgery group experienced less post-operative pain. CONCLUSION: Besides an improvement in the esthetic result, vide o-surgery dissection of the saphenous vein reduces post-operative pain at the cost of a slightly longer operative procedure. (C) 1998, Masso n, Paris.