Endoscopic saphenectomy for coronary artery bypass surgery: Comparison of two techniques with and without carbon dioxide insufflation

OBJECTIVE: To compare the clinical results of an initial experience with tw o techniques of endoscopic saphenectomy with and without gas insufflation. DESIGN: A retrospective study was performed between September 1998 and Marc h 1999 on 40 patients who underwent endoscopic saphenectomy for coronary ar tery bypass graft without (group 1, n=15) and with (group 2, n=25) carbon d ioxide insufflation. INTERVENTIONS: In both groups, the site of harvesting was at the knee throu gh a 2 cm incision. In group 1, dissection was performed using a hand-held dissector while in group 2 dissection was performed after ensuring that the re was a seal at the knee and insufflation of carbon dioxide. Collaterals w ere controlled with an endoclipper in group 1 and bipolar scissors in group 2. Intraoperative procedure time, length of the harvested vein and aspect of the thigh (ecchymosis, hematoma, infection) were recorded. RESULTS: Vein trauma occurred in four patients in group 1 (four of 15, 27%) and in one in group 2 (one of 25, 4%). Hematomas developed in four patient s in group 1 (four of 15, 27%) and in one patient in group 2 (one of 25, 4% ). Wound infection occurred in no patients in group 1 and in one patient in group 2. One patient in group 2 suffered carbon dioxide embolism with no u ntoward consequences. Conversion to an open technique was necessary in five patients in group 1 (five of 15, 33%) and in two patients in group 2 (two of 25, 8%). CONCLUSIONS: Endoscopic saphenectomy both with and without carbon dioxide i nsufflation is associated with a low infection rate, but vein trauma and wo und hematomas are more common without carbon dioxide insufflation.