Should we use video-assisted endoscopic vein harvesting as a standard technique?

Background: To investigate the feasability and results of endoscopic vein h arvesting (EVH) using the Vasoview Uniport(R) system (Guidant Corporation, Menlo Park,CA). Can this technique be used as a standard technique for vein harvesting in coronary artery bypass surgery (CABG) or is it too time cons uming? Do smaller incisions result in less morbidity and discomfort? Methods: From October 1998 to May 1999, 158 patients who underwent CABG wit h venous grafts, in addition to arterial grafts, formed the study populatio n for EVH. In group A (n=131) the vein was harvested with the Vasoview Unip ort System. In group B (n=27) the vein was harvested by a conventional open technique with interrupted incisions because of unavailability of the equi pment. Recordings were made on vein length, harvest time, length of incisio n, and complications. Results: In none of the patients in group A was a conversion to the open te chnique necessary. In 72/131, pure EVH was used. In 59/131 an additional in cision below the knee was used for harvesting extra vein length. Mean harve sted vein graft length (cm) was 35.9 (range 18-56) in group A and 30.6 (ran ge 16-51) in group B, and mm of vein harvested/min was 77 and 71 in group A and B. Mean time for harvesting and closing (min) was 56.1 (range 14-120) SD 20.4 and 78.3 (range 37-129) SD 26 for a mean length of incision (cm) of six (ra nge 2-19) and 27 (range 12-54). Wound complications at postoperative day th ree at discharge, and after six weeks were seen in 30 (23%), 27 (20%) and f our (4%) patients of group A, and in five (18%), five (18%) and four (23%) of group B. Conclusions: Despite a learning curve in using endoscopic techniques, the t otal procedural time for EHV is acceptable and even shorter than open harve sting. Most of the time is gained in closure of the wound. Hematoma formati on is the most common peroperative complication, but diminishes with experi ence. The absence of postoperative edema after EVH is striking. Despite the higher costs for disposable material, we have adopted EVH as a standard te chnique since patient and surgeon satisfaction have improved substantially.