ENDOSCOPIC HARVEST OF SAPHENOUS-VEIN GRAFT FOR CORONARY-ARTERY BYPASS-GRAFTING - SAITAMA-OLYMPUS TECHNIQUE

Objective: This study was undertaken to examine the clinical feasibili ty of a newly developed video-assisted endoscopic technique (Saitama-O lympus technique) to harvest saphenous vein graft (SVG) in 40 CABG pat ients. Methods: There were 37 males and three females with an average age of 59 +/- 11 years. The special instruments developed were optical sheath, solid dilators, tunnel retractor, vessel dissector, GCC force ps which were utilized in conjunction with the thoracoscopic surgery s ystem (Olympus, Tokyo, Japan). The course of the saphenous vein (SV) w as marked on the skin prior to operation. SV was identified in the fem oral region with a 4-cm skin incision and dissected with an open techn ique. The anterior surface of SV was dissected for 30 cm by the optica l sheath mounted on the endoscope. Then another 4-cm skin incision abo ve SV was placed in the popliteal region, resulting in a subcutaneous space over the SV. The subcutaneous space was then dilated and maintai ned with the tunnel retractor which has an endoscope channel at the to p. With this system SV was visualized stably by endoscope without any assistance. All side branches were dissected and divided with the vess el dissector. When longer SVG is required, the same procedure was exte nded to the ankle with additional one or two skin incisions. Results: SV was easily harvested in all patients with spending 15-84 min. The a verage number of skin incisions was 2.4 +/- 0.5 and the average length of the harvested SVG was 41 +/- 12 cm. The average number of bypassed grafts was 3.4 +/- 1.0 with use of left internal mammary artery (IMA) in 31 patients. The average operation time was 272 +/- 52 min, there were no significant prolongation relating to endoscopic SVG harvesting . The remainder of SVG in each patients was pathologically examined an d there were no evidence of intimal injury. There were no major wound complications during the average follow-up of 10 +/- 4 months and this technique seemed to be advantageous for patients with less wound pain and better cosmetic appearance. Conclusions: The Saitama-Olympus tech nique to endoscopically harvest the SV is a clinically feasible surgic al technique with the unique potential of a significant reduction in m orbidity and decreased wound scarring in CABG patients. (C) 1998 Elsev ier Science B.V. All rights reserved.