Video-assisted endoscopic saphenous vein harvesting for coronary artery bypass grafting

Saphenous vein grafts for coronary artery bypass can be harvested by means of the traditional long incision method, the skin bridge method, or a newly developed endoscopic technique. We applied the endoscopic technique to reduce the length of leg incision and to decrease the frequency of complications. Between September and December 1996, 47 patients underwent coronary artery bypass grafts, 17 of whom volunteered to undergo saphenous vein harvest with the Endopath video-assisted endoscopic saphenous vein harvest (ESVH) system; the other 30 patients underwent the traditional long incision harvest procedure. A total of 22 saphenous veins were harvested from the 17 patients who underwent ESVH. The mean length of the leg wound was 5.8 +/- 1.3 cm and the mean length of the vein harvested was 32.9 +/- 3.4 cm (wound/vein length ratio 17.6%). The wound/vein length ratio of the 30 patients who underwent the traditional open harvest method was 91.5% (30.8 +/- 2.2 cm/34.1 +/- 3.0 cm). ESVH failed and was converted to the conventional method in two cases. The mean time required to harvest the saphenous vein was 72.7 +/- 20.8 minutes in the ESVH group and 45.8 +/- 12.5 minutes in the open surgery group. No wound complications were noted in the ESVH group, except for ecchymosis in three cases. Five patients in the open surgery group had wound discharge (17%). The length of hospital stay was shorter (10.5 +/- 2.6 days vs 15.8 +/- 4.2 days) and fewer analgesics were used in the ESVH group. The rate of cardiac complications was not different between the two groups. Examination of the vein graft under light microscopy also did not reveal any differences. We conclude that the endoscopic technique can provide adequate vein grafts for use in coronary artery bypass grafting and reduce the leg wound complication rate, hospital stay, and use of analgesics.