We have located links that may give you full text access.
Comparative Study
Journal Article
Routine minimal invasive vein harvesting reduces postoperative morbidity in cardiac bypass procedures. Clinical report of 1400 patients.
European Journal of Cardio-thoracic Surgery 1999 November
OBJECTIVE: Minimal invasive endoscopic vein harvesting has not gained widespread acceptance although potential improvements in wound healing and patient comfort are undebatable. The main objections to routine application have been impaired graft quality and prolonged operation time. The feasibility of introducing the minimal invasive approach to vein harvesting into a high volume cardiac bypass surgery program was to be investigated in 1400 patients.
METHODS: Our preferred technique is based on standard videoscopic equipment for endoscopic surgery. No disposables are used. The subcutaneous tissue above the saphenous vein is tunnelled by exclusively sharp dissection. No shear stresses are applied to the vein graft or its side branches. Side branches are closed by clips or bipolar coagulation. The differences between endoscopic and conventional surgical vein harvesting with regard to operation time, graft quality, wound healing disturbances and postoperative pain were compared in two groups of 300 concurrently operated patients. Subsequently, a further 1100 patients underwent endoscopic vein harvesting, giving a total experience of 1400 endoscopic procedures.
RESULTS: After a learning curve of approximately 100 procedures for an experienced surgeon, harvesting time using minimal invasive techniques was 16 +/- 4 min/graft vs. 10 +/- 2 min for the conventional technique (P < 0.01). Severe wound healing disturbances requiring re-intervention were observed in 0.1% following endoscopic harvesting, moderate wound healing disturbances were observed in 1.7% of patients. By comparison, conventional harvesting led to severe wound healing disturbances in 5% and to moderate disturbances in 8% (P < 0.05). Incidence of peri-operative myocardial infarction as an indirect measure of graft quality was 1.7% with endoscopic vs. 2.3% (n.s.) with conventional technique. Early postoperative mobilisation was faster, pain and need of analgesics were distinctly reduced in patients with endoscopic harvesting. Overall operation time was not significantly prolonged by the described technique.
CONCLUSIONS: Minimal invasive endoscopic vein harvesting can be developed into a routine procedure resulting in a lower incidence of wound complications, less postoperative pain and much superior cosmetic results. Graft quality appears to be comparable to standard saphenectomy. There is, however, a higher demand of surgical training and expertise.
METHODS: Our preferred technique is based on standard videoscopic equipment for endoscopic surgery. No disposables are used. The subcutaneous tissue above the saphenous vein is tunnelled by exclusively sharp dissection. No shear stresses are applied to the vein graft or its side branches. Side branches are closed by clips or bipolar coagulation. The differences between endoscopic and conventional surgical vein harvesting with regard to operation time, graft quality, wound healing disturbances and postoperative pain were compared in two groups of 300 concurrently operated patients. Subsequently, a further 1100 patients underwent endoscopic vein harvesting, giving a total experience of 1400 endoscopic procedures.
RESULTS: After a learning curve of approximately 100 procedures for an experienced surgeon, harvesting time using minimal invasive techniques was 16 +/- 4 min/graft vs. 10 +/- 2 min for the conventional technique (P < 0.01). Severe wound healing disturbances requiring re-intervention were observed in 0.1% following endoscopic harvesting, moderate wound healing disturbances were observed in 1.7% of patients. By comparison, conventional harvesting led to severe wound healing disturbances in 5% and to moderate disturbances in 8% (P < 0.05). Incidence of peri-operative myocardial infarction as an indirect measure of graft quality was 1.7% with endoscopic vs. 2.3% (n.s.) with conventional technique. Early postoperative mobilisation was faster, pain and need of analgesics were distinctly reduced in patients with endoscopic harvesting. Overall operation time was not significantly prolonged by the described technique.
CONCLUSIONS: Minimal invasive endoscopic vein harvesting can be developed into a routine procedure resulting in a lower incidence of wound complications, less postoperative pain and much superior cosmetic results. Graft quality appears to be comparable to standard saphenectomy. There is, however, a higher demand of surgical training and expertise.
Full text links
Related Resources
Trending Papers
Challenges in Septic Shock: From New Hemodynamics to Blood Purification Therapies.Journal of Personalized Medicine 2024 Februrary 4
Molecular Targets of Novel Therapeutics for Diabetic Kidney Disease: A New Era of Nephroprotection.International Journal of Molecular Sciences 2024 April 4
The 'Ten Commandments' for the 2023 European Society of Cardiology guidelines for the management of endocarditis.European Heart Journal 2024 April 18
A Guide to the Use of Vasopressors and Inotropes for Patients in Shock.Journal of Intensive Care Medicine 2024 April 14
Diagnosis and Management of Cardiac Sarcoidosis: A Scientific Statement From the American Heart Association.Circulation 2024 April 19
Essential thrombocythaemia: A contemporary approach with new drugs on the horizon.British Journal of Haematology 2024 April 9
Get seemless 1-tap access through your institution/university
For the best experience, use the Read mobile app
All material on this website is protected by copyright, Copyright © 1994-2024 by WebMD LLC.
This website also contains material copyrighted by 3rd parties.
By using this service, you agree to our terms of use and privacy policy.
Your Privacy Choices
You can now claim free CME credits for this literature searchClaim now
Get seemless 1-tap access through your institution/university
For the best experience, use the Read mobile app