Endoscopic vs. conventional vein harvesting: first results with a new, non-disposable system.
BACKGROUND
Most of the grafts used in coronary bypass surgery are still venous grafts. The preferred vein for bypass surgery is the long saphenous vein. Severe wound complications caused by saphenous vein harvesting occur in 1 % to 3 % of cases. Minor complications that do not need surgical revision occur in up to 43 % of cases. We developed an endoscopic harvesting technique using non-disposable instruments to reduce wound complications caused by vein harvesting.


METHODS
In a retrospective study, the occurrence of wound complications, haematoma, postoperative pain, ambulation, sensory disturbances and patient satisfaction were studied (n = 182). Patients who had either endoscopically harvested (n = 91) or conventionally harvested (n = 91) saphenous vein grafts were reviewed.


RESULTS
Results were collected for 173 patients. The overall prevalence of wound complications was 18.7 %. The incidence of wound healing complications could be reduced significantly (p = 0.015) from 15.3 % to 3.4 % using the endoscopic technique. In the endoscopic group, postoperative ambulation was significantly (p = 0.002) easier, patient satisfaction was significantly (p = 0.007) higher, and postoperative leg swelling (p = 0.003) and haematoma (p = 0.004) could be reduced significantly. The occurrence of postoperative pain and sensory disturbances did not differ significantly.


CONCLUSIONS
We conclude that the used endoscopic vein harvesting is a safe and cost effective method that can significantly reduce wound complications. An ongoing prospective study should establish our demonstrated data.
Lutz
C W
CW
Department of Cardiovascular Surgery, University Clinic, Albert-Ludwigs-University Freiburg, Hugstetterstrasse 55, 79106 Freiburg, Germany. lutzch@ruf.uni-freiburg.de
Hillmann
R
R
Lutter
G
G
Schoellhorn
J
J
Beyersdorf
F
F
D000368:Aged; D004724:Endoscopy; D005260:Female; D005500:Follow-Up Studies; D006406:Hematoma / Q000209:etiology; D006801:Humans; D015994:Incidence; D007866:Leg / Q000098:blood supply / Q000473:pathology; D008297:Male; D008875:Middle Aged; D010149:Postoperative Pain / Q000209:etiology; D017060:Patient Satisfaction; D012189:Retrospective Studies; D012501:Saphenous Vein / Q000601:surgery; D012720:Severity of Illness Index; D020858:Tissue and Organ Harvesting; D016896:Treatment Outcome; D014945:Wound Healing