Endoscopic vein harvest: early results of a prospective trial with open vein harvest.
BACKGROUND
Conventional open long saphenous vein harvest (OVH) is often associated with significant wound pain and serious morbidity in some patients with a resultant extended treatment period. Endoscopic vein harvest (EVH) in theory should alleviate wound pain, be less predisposed towards leg wound infection and lead to greater patient satisfaction. This study aims to compare the two techniques on this basis and determine whether EVH is a viable technique within normal operative time.


METHODS
During September and December 2000, 60 saphenous vein harvests were prospectively randomised to EVH (n=30) and OVH (n=30); all performed by one surgeon with the Clearglide(r) endoscopic vein harvest system (Ethicon Inc). End points were impaired wound healing (ASEPSIS score) and postoperative pain (Visual analogue scale) and operative variables. Statistical analysis done using Fisher s exact test and Mann-Whitney U test as appropriate.


RESULTS
The groups were well matched demographically. Patients in the EVH group had significantly lower ASEPSIS scores (p<0.001) and postoperative pain (p<0.001). The vein was harvested at 0.96cm/min (0.43-1.5+/-0.33) in the OVH group compared to 0.81cm/min (0.41-1.13+/-0.19) in the EVH group (p=0.09). The new procedure did not prolong the overall operative time (p=0.53). Two patients needed to be converted to open technique. There was no difference found in the vein quality by histological analysis.


CONCLUSIONS
These data clearly demonstrate that endoscopic vein harvest results in significantly reduced post-operative pain, better impaired wound healing, allows earlier ambulation and does not prolong the operative time significantly with no compromise in vein quality.
Bonde
P
P
Royal Victoria Hospital, United Kingdom.
Graham
A
A
MacGowan
S
S
D000368:Aged; D017546:Angioscopy; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010149:Postoperative Pain / Q000517:prevention & control; D011182:Postoperative Care; D011300:Preoperative Care; D011446:Prospective Studies; D012501:Saphenous Vein; D018709:Statistics, Nonparametric; D020858:Tissue and Organ Harvesting / Q000009:adverse effects / Q000379:methods*; D020535:Video-Assisted Surgery; D014945:Wound Healing