title: A comprehensive review on learning curve associated problems in endoscopic vein harvesting and the requirement for a standardised training programme.
abstract: Endoscopic vein harvesting is becoming one of the most favourable vein harvesting techniques in multiple bypass coronary surgery, due to its short term post-operative benefits with high patient satisfaction. However, long-term graft patency has been both supported and questioned in the literature. Graft failure can be affected by harvesting methods and operator's experience. Endoscopic vein harvesting is associated with a learning curve period, during which the incidence of vein trauma is high due to unfamiliarity with the surgical technique. There is a paucity of structured learning tools for novice practitioners, meaning that training differs significantly between hospital centres. Inconsistent training methods can lead to poor surgical technique, which can have a significant impact on vein quality and stress level of the practitioner. In turn, this can lead to increased postoperative complications and longer surgical duration. The main aim of this literature review is to understand the impact of the learning curve on the vein conduit and whether there is a requirement for a standardised training programme for the novice practitioners.
authors.affiliation: Department of Cardiothoracic Surgery, University Hospital of South Manchester NHS Foundation Trust, Manchester, M23 9LT, UK. bhuvaneswari.bibleraaj@uhsm.nhs.uk.
authors.forename: Bhuvaneswari
authors.initials: B
authors.lastname: Krishnamoorthy
authors.affiliation: The Transplant Centre, University Hospital of South Manchester NHS Foundation Trust, Manchester, M23 9LT, UK.
authors.forename: William R
authors.initials: WR
authors.lastname: Critchley
authors.affiliation: Department of Cardiothoracic Surgery, University Hospital of South Manchester NHS Foundation Trust, Manchester, M23 9LT, UK.
authors.forename: Rajamiyer V
authors.initials: RV
authors.lastname: Venkateswaran
authors.affiliation: Department of Cardiothoracic Surgery, University Hospital of South Manchester NHS Foundation Trust, Manchester, M23 9LT, UK.
authors.forename: James
authors.initials: J
authors.lastname: Barnard
authors.affiliation: The School of Nursing, Midwifery and Social Work, University of Manchester, Manchester, M13 9NT, UK.
authors.forename: Ann
authors.initials: A
authors.lastname: Caress
authors.affiliation: The Transplant Centre, University Hospital of South Manchester NHS Foundation Trust, Manchester, M23 9LT, UK.|Institute of Inflammation and Repair, Faculty of Medical and Human Sciences, University of Manchester, Manchester, M13 9PL, UK.
authors.forename: James E
authors.initials: JE
authors.lastname: Fildes
authors.affiliation: Department of Cardiothoracic Surgery, University Hospital of South Manchester NHS Foundation Trust, Manchester, M23 9LT, UK.|The Transplant Centre, University Hospital of South Manchester NHS Foundation Trust, Manchester, M23 9LT, UK.
authors.forename: Nizar
authors.initials: N
authors.lastname: Yonan
mesh_terms: D002983:Clinical Competence; D001026:Coronary Artery Bypass / Q000379:methods; D004724:Endoscopy / Q000193:education* / Q000379:methods*; D006085:Graft Survival; D006801:Humans; D059032:Learning Curve; D008875:Middle Aged; D011183:Postoperative Complications; D012501:Saphenous Vein / Q000637:transplantation*; D013997:Time Factors; D020858:Tissue and Organ Harvesting / Q000193:education*
keywords: Coronary artery bypass; Endoscopic vein harvesting; Learning curve; Saphenous vein