Endoscopic saphenous vein harvesting: initial experience and learning curve

Area of Science:

• Cardiovascular Surgery
• Minimally Invasive Surgical Techniques
• Vascular Surgery

Background:

• Saphenous vein grafts are crucial for coronary artery bypass grafting (CABG), typically harvested via open incisions with associated morbidity (5-25%).
• Endoscopic vein harvesting (EVH) was developed to reduce surgical site morbidity and improve outcomes.
• This study evaluates the feasibility, learning curve, and outcomes of EVH in a novel patient cohort.

Purpose of the Study:

• To assess the feasibility and reproducibility of the endoscopic vein harvesting (EVH) technique.
• To analyze the learning curve associated with EVH for coronary artery bypass grafting.
• To evaluate the clinical outcomes and morbidity of EVH in a new surgical group.

Main Methods:

• 179 patients undergoing CABG between July 1998 and October 1999 had EVH performed by two surgeons.
• Data collected included harvesting time, conduit length, technical aspects, and clinical outcomes.
• Results were analyzed across six sequential groups of 30 patients to track learning curve progression.

Main Results:

• The EVH procedure was primarily performed on the thigh (77.65%) with an average of 2.45 incisions.
• Mean conduit length was 34.96 cm, with an average of 1.30 grafts per patient.
• Overall morbidity was 8.9%, including infection (6.7%) and hematoma (1.11%), with a 95.54% primary success rate.

Conclusions:

• Endoscopic vein harvesting is a feasible and reproducible technique for CABG.
• The method exhibits a predictable learning curve and acceptable morbidity rates.
• EVH provides clear benefits for patients requiring saphenous vein grafts in bypass surgery.