 |
 |
| Editor's Note |
by Vassilios Gulielmos, MD
Geniki Kliniki Thessaloniki, Thessaloniki, Greece |
|
|
Endoscopic Harvesting
When in the mid 90´s the new wave in cardiac surgery was initiated, it seemed strange that although the trend was to reduce procedural trauma using small incisions or even working endoscopically, cardiac surgeons would still perform the longest skin incision in human for saphenous vein harvesting.
So, the next goal was there: smaller skin incisions or endoscopic surgery for conduit harvesting, both for saphenous vein segments and radial arteries. Industry very soon recognized the opportunity and responded with kits utilizing small incisions for graft harvesting at the beginning, and for totally endoscopic harvesting later on.
The systems available using small skin incisions included tools either reusable or disposable and were successfully used after a certain learning curve, mostly not longer than 10 procedures. For endoscopic harvesting, techniques more often harvesting kits are disposable. Learning curve is then longer, most times reaching around 20 to 25 procedures.
These systems faced criticism mostly by so called non-adaptors, with the argument of not being sure about the quality of the conduit, or of being difficult, slow, or expensive. However patient's demand and fair initial results forced the majority of surgeons to try them.
Published series reported about even or better histological results in favor of the endoscopic techniques, probably due to more sophisticated instrumentation and less exposure to the atmospheric oxygen. The question for easiness and speed of the procedure was well answered by reports about learning curves. These showed that after a certain number of procedures, doctors became even faster with these novel techniques, also showing that money spent for the devices was reimbursed by having less wound complications.
At the endpoint, studies report that patients ask for this procedure for better cosmesis, less pain and fear before long skin incisions.
Prospective randomized trials are ongoing, comparing the conventional with endoscopic techniques in several points of view supported from insurance companies in Germany. If these trials reveal superior medical, and economical outcome in favor of the endoscopic techniques, reimbursement will always be provided and even additional support for their use should be expected. Institutions already using these novel techniques will then benefit against others only performing conventional conduit harvesting.
« Minimally Invasive Conduit Harvesting for Coronary Bypass Grafting
« Endoharvesting
« Join the discussion
|
|
|
|