Endoscopic harvesting of the greater saphenous vein for aortocoronary bypass grafting

We conducted an observational study to evaluate the effectiveness of an end oscopic technique for harvesting the greater saphenous vein for aortocorona ry bypass grafting. We hypothesized that the endoscopic technique would min imize the risk of postoperative wound complications. From May 1997 to July 1998 we used an endoscopic technique to harvest the greater saphenous vein in 50 patients who underwent aortocoronary artery bypass grafting. Twenty-f ive of the patients had an increased risk for wound complications due to pr eexisting diabetes, obesity, peripheral vascular disease, or lymphedema. The average duration of the procedure was 39 minutes (range, 11 to 70 minut es). The average length of the harvested vein was 58 cm (range, 25 to 85 cm ). We made an average of 2.5 incisions per patient (range, 1 to 5 incisions ), and the average incision length was 7 cm (range, 3 to 10 cm). Two patien ts (4%) required conversion to an open technique using 5 small incisions. P ostoperative complications included 1 wound infection (2%) and 1 small hema toma (2%). Two patients (4%) had minor erythema at the incision site, and 5 patients (10%) had postoperative lymphedema. The most common problem, ecch ymosis, was seen in 6 patients (12%). None required repeat hospitalization or reoperation for wound complications. In our study, the endoscopic approach yielded superior cosmetic results, an d reduced wound complications and discomfort, compared with traditional met hods of vein harvesting. After gaining expertise with this minimally invasi ve method of vein harvesting, a surgeon can safely remove the saphenous vei n in 20 to 30 minutes.