Endoscopic Vein Harvesting for Coronary Artery Bypass Grafting

The authors present a case of endoscopic saphenous vein harvesting for coronary artery bypass grafting (CABG) using a reusable retractor with an open CO₂ insufflation system. 
Prior to the procedure, the venous system of the lower extremities was routinely evaluated using ultrasound. The saphenous vein was assessed for quality and suitability for endoscopic harvesting, and the projection of the vein on the skin was marked. 
 
The surgeons used a reusable endoscopic artery retractor with an open CO₂ insufflation system and a LigaSure system for tissue dissection. This system was used for both harvesting the radial artery and the vein. 
 
Before harvesting, the patient's leg was positioned with the knee flexed at a 90-degree angle. A 3-4 cm incision was made above the knee fold at a pre-marked site. The vein was identified and dissected to create a space for the retractor. Before endoscopic vein harvesting, 5,000 international units (IU) of heparin were administered. Dissection began at the anterior surface of the vein, and a tunnel was formed. To avoid injury to venous branches, all surrounding tissues were coagulated using the LigaSure device, and the retractor was advanced without resistance. Typically, the surgeons proceed with the left side and then the right side of the vein, though the sequence may vary depending on individual cases. Tissue dissection was performed widely and away from the vein to minimize the risk of vascular injury. The inferior surface of the vein was passed last. At this stage, it was critical to check that no part of the vein was caught in the LigaSure jaws. Before division, all sides of the vein were inspected. The proximal end was divided with multiple passes of the device. The distal end of the vein was cannulated and ligated. 

The harvested vein was cleaned of surrounding tissues, and all branches were additionally securely with clips. The vein was marked with methylene blue dye (water based) to avoid twisting during CABG. At the end of the harvesting procedure, additional wound hemostasis was performed, followed by only skin suturing without drainage. Postoperative care was standard and required no specific modifications. 

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