Minimally Invasive Endoscopic Radial Artery And Saphenous Vein Harvesting With A Non-sealed Approach
Fabrizio Rosati, MD, Gianluigi Bisleri.
Division of Cardiac Surgery, Kingston Health Science Centre, Queen's University, Kingston, ON, Canada.
OBJECTIVE: Minimally invasive approaches for grafts procurement are associated with excellent outcomes in terms of morbidity and patients' discomfort thus without affecting graft quality, patency rate and long-term outcomes in patients undergoing CABG surgery. We aim to extensively describe the technique for endoscopic radial artery(RA) and saphenous vein(SV) harvesting using non-sealed approach for grafts procurement during CABG surgery.
METHODS: All patients scheduled for coronary artery bypass surgery can potentially benefit of an endoscopic approach when the use of RA and/or SV is planned. In this video, endoscopic harvesting of radial artery and saphenous vein were performed by means of non-sealed system. Non-sealed systems do not require active carbon dioxide insufflation; however, CO2 may be used as a visual flush without any occlusive port at the entry point, thus, adoption of a non-sealed approach, encompasses any potential drawbacks of active CO2 insufflation.
RESULTS: Endoscopic harvesting for RA and SV showed similar macroscopic results when compared to "open" techniques. Microscopically, structural and functional viability of the endothelium and vasoreactivity are preserved after endoscopic harvesting. Detrimental effects were demonstrated on functional and structural properties of the SV and RA and such changes are significantly higher when a "sealed system" approach is used. Minimally invasive techniques demonstrated significant better outcomes in terms of incidence of wound and neurological complications as well as patients' satisfaction when compared to "open" techniques for graft harvesting. Harvesting-related pain and discomfort, mobility and sensory disfunction are significantly less relevant after minimally invasive conduit harvesting.
CONCLUSIONS: In conclusion, increasing evidences support the use of endoscopic approaches for graft procurement and such techniques showed to be safe and effective with comparable results in terms of graft quality and cardiac related adverse events but a significantly superiority in terms of complications and patients' satisfaction when compared to open approaches
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