Endoscopic vein harvest: advantages and limitations

Area of Science:

• Cardiovascular Surgery
• Minimally Invasive Techniques
• Surgical Outcomes

Background:

• Traditional open vein harvest (OVH) for coronary revascularization is associated with impaired wound healing and postoperative pain.
• Endoscopic vein harvest (EVH) aims to reduce patient morbidity and improve satisfaction without compromising surgical outcomes.

Purpose of the Study:

• To compare the efficacy and safety of EVH versus OVH in saphenous vein harvesting for coronary revascularization.
• To evaluate wound healing, operative time, vein quality, and postoperative pain between EVH and OVH.

Main Methods:

• A prospective randomized trial comparing EVH (n=52) with OVH (n=56) for saphenous vein harvesting.
• Endpoints included wound healing (ASEPSIS score), operative time, vein quality, and pain (Visual Analog Scale).
• Follow-up extended up to 3 years.

Main Results:

• EVH demonstrated significantly better wound healing (p < 0.01) and reduced postoperative pain (p < 0.01) compared to OVH.
• EVH was quicker when two grafts were required (p < 0.01) and did not prolong overall operative time (p = 0.77).
• OVH group required more late interventions for wound-related morbidity.

Conclusions:

• EVH is a superior technique for saphenous vein harvesting, leading to improved wound healing and decreased pain.
• EVH does not compromise vein quality or significantly increase operative time.
• EVH offers advantages in efficiency for multiple grafts and reduces the need for subsequent interventions.