BACKGROUND: Endoscopic conduit harvesting has been the gold standard for saphenous vein harvesting in coronary bypass surgery. Endoscopic harvesting requires expensive, single-use materials. This study reports on a technique using fully reusable materials for endoscopic conduit harvest, an adaptation of the non-sealed approach. To this date, no fully reusable technique has been described, compromising adoption of endoscopic conduit harvesting worldwide due to cost restraints. METHODS: Our approach was used in all patients requiring coronary bypass grafting with the use of a secondary conduit, usually the saphenous vein. A total of 300 patients were enrolled between 2022 and 2023. The technique starts with ultrasound mapping, significant branches are marked using a marker, the anatomical location of the saphenous vein and possible challenges can be predicted and pitfalls prevented. Vein wall abnormalities can be reported during ultrasound mapping. A frog-like leg flexion is needed, support for the thigh and knee is provided with padding. A small 2 cm incision is made in the medial popliteal region. The first centimeters of the vessel are dissected using conventional methods, a vessel loop is used to serve as a light traction device. Vein branches are sealed using the reusable Olympus Sonosurg vessel sealer. The Karl Storz Bisleri retractor is advanced. A tunnel structure is formed while advancing the retractor and vein branches are sealed. A no-touch technique(3) can be safely and easily implemented with better avoidance of thermal injury. The dissection distance from the knee to the groin can provide 25-30 centimeters of conduit. If an extensive length of conduit is needed the retractor can be advanced distally to the leg. A stab and clip technique is used at the proximal end. All conduits were reviewed by a pathologist for signs of conduit/intimal damage. RESULTS: Histological analysis of all conduits reported no intimal or conduit damage(1,2), Median Number of grafts was 2,2. Median total harvest time was 27min. No early graft failure was observed in this initial report. Ten minor complications with localized hematoma have been reported. Two cases of superficial infection at the site of incision and one case of major infection, attributed to rupture of endoscope plastic sheath, requiring oral antibiotics and a close outpatient follow up. Our infection rate was 1% in this case series. CONCLUSIONS: The adapted non-sealed technique with fully reusable materials is feasible and changed our practice drastically. This approach can be used worldwide even in countries with restricted financial support and would also reduce hospital waste and spending. A small learning curve is expected in the first 15 cases. Patients greatly appreciate the endoscopic technique. The quality of life for the surgeon, inpatient or outpatient, regarding infection control and surgical ergonomics is a game changer.
