Internal saphenous vein harvesting for aorto-coronary bypass by endoscopy.

Classical excision of saphenous vein grafts requires a continuous incision on the leg or the thigh or both. To minimise the trauma due to this method, an endoscopic method has been recently developed. The aim of this paper wa s to assess the benefits of this new method compared with the classical tec hnique. One hundred and twenty patients requiring aorto-coronary grafts were includ ed in this prospective study and divided into two groups according to the m ethod of saphenous vein harvesting. Group A comprised 60 patients who underwent the classical method os sapheno us vein harvesting and Group B 60 patients who benefited from the endoscopi c method. No difference was observed between the two groups with respect to mean age, sex ratio, history of diabetes and obliterative arterial disease of the lower limbs, Parsonnet index number of bypass grafts and length of vein excised. The length of the skin wound in group A was 30.8 +/- 8.5 cm compared with o nly 4.1 +/- 1 cm in Group B (p= 0.006) but the harvesting time was longer b y endoscopy (55.7 +/- 23.7 minutes : 72.5 +/- 22.6 minutes for the first 10 patients, 48.5 +/- 24.7 minutes for the last SO patients) compared with th e classical technique (39.8 +/- 6.6 minutes; p= 0.001). Moreover, patients who underwent videosurgery had less operative pain (8% versus 15%) (p= 0.00 1). The number of infectious complications was slightly lower in Group B (3.3%, 2/60, versus 10%, 6/60), (NS). The authors conclude that harvesting of the saphenous vein by videosurgery reduces postoperative pain and gives a more aesthetic result but with a sli ghtly longer operative time at the beginning of the experience.