Ann Thorac Surg 2000;69:1938
© 2000 The Society of Thoracic Surgeons
Invited commentary
Invited commentary
Friedhelm Beyersdorf, MDa
a Department of Cardiovascular Surgery, Albert-Ludwigs University Freiburg, Hugstetterstrasse 55, D-79106 Freiburg, Germany
e-mail: beyers{at}ch11.ukl.uni-freiburg.de
Endoscopic harvest of the greater saphenous vein is a true minimal invasive procedure with many advantages for patients and is associated with a very low risk rate. After conventional open removal on the greater saphenous vein, postoperative minor complications are common and patients often experience painful sensations. Minimally invasive endoscopic harvesting of the entire greater saphenous vein is possible through one single skin incision, thus avoiding potential infections, especially in the groin. Many different systems exist for minimal invasive endoscopic vein harvesting (including systems for single and multiple use, with and without CO2-insufflation, etc). The conversion rate into the open conventional technique is necessary in up to 10% and can be performed without any additional risk for the patient. Therefore the potential advantages of this technique (less acute and chronic pain, less wound morbidity, faster mobility of the patient) clearly outweigh minor complications associated with this procedure.
The report of Lehmann and coworkers describes one of these rare complications of endoscopic vein harvesting using CO2-insufflation. This complication was managed very successfully by the authors and has not been reported in the literature before. This report, however, is able to focus on this potential complication for this specific harvesting procedure and is therefore very helpful for the scientific community.
However, even though a number of reports have demonstrated the clear advantages of the endoscopic minimal invasive saphenous vein harvest procedure as compared to the conventional open technique, more data are necessary to address the potential damage of the vein endothelium during endoscopic approach. In all published reports so far no acute vein graft closures have been reported, but more detailed histomorphologic studies are necessary to demonstrate the complete intactness of the vein endothelium after this new approach for harvesting.
In addition, the percentage of patients revascularized by complete arterial grafting is increasing and future developments will show if endoscopic arterial harvesting for the radial and gastroepiploic artery will be feasible.
Related Article
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Pneumoperitoneum secondary to endoscopic harvest of saphenous vein graft
- Andreas Lehmann, Johannes Lang, Udo Weisse, and Joachim Boldt
Ann. Thorac. Surg. 2000 69: 1937-1938.
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