Q.What is endoscopic vein harvesting?
A. By John Robertson, M.D., Chief of Thoracic and Cardiovascular Surgery at Saint John’s Health Center
Endoscopic vein harvesting is a new technique used during coronary artery bypass surgery. During heart bypass surgery, the surgeon takes a segment of a healthy blood vessel (vein) from another part of the body – usually the leg – and uses it to create a detour or bypass around the blocked part of the coronary artery in the chest. This process is called vein harvesting. It traditionally was accomplished through a long incision in the leg, sometimes from groin to the ankle.
This leg incision was always a problem for patients during recovery. When patients would come to my office for their postoperative appointment a week or so after surgery, they would always complain about their leg wound. It was painful, red and oozing. They were worried it was infected, and they couldn’t walk on it.
Some of the cardiovascular physician assistants got together with doctors and medical device companies and started investigating ways to harvest the vein through smaller incisions. They developed the endoscopic vein-harvesting device that we now use. With the new technique, we make a single tiny incision of about one to two centimeters in the skin of the knee, insert this long tubular device down the leg and create a tunnel with gas. This device has a scope with a camera, a clamp that grabs the vein, and a piece that slides up and down along the vein using radiofrequency to cut it free. We can then take any length of vein we need by pulling it up and out through the single incision at the knee. It takes about 40 minutes for the whole procedure — a dramatic difference. The old technique used to take 30 to 40 minutes just to cut open the leg. We’ve been performing endoscopic vein harvesting at Saint John’s for a couple years now and the complication rate is almost zero. In fact, Saint John’s is the leading institution that performs this technique with only one incision. Many places do it with three incisions, in the groin, knee and ankle.
Patient satisfaction with this new technique is superb. It’s really a dramatic improvement. People are able to get up and walk the first day after surgery. And they forget all about the incision in their leg. At the postoperative appointment, I’ll ask patients, “How’s your leg?” and they’ll say, “My leg, what’s wrong with my leg?”
John Robertson, M.D., is Chief of Thoracic and Cardiovascular Surgery at Saint John’s Health Center. For more information about Dr. Robertson and other Saint John’s services, please call (310) 829-8990 or visit the website at www.stjohns.org. For a physician referral or a second opinion, please call 1-888-ASK-SJHC.
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