Minimally Invasive Vein Harvesting with the SaphLITE Retractor System: Is It Really Better?
Background. The value of newly developed techniques for saphenous vein harvesting remains controversial. Which technique offers the most benefits is still unknown. The aim of this study was to compare the conventional vein harvesting through a continuous skin incision method with 2 less invasive methods and evaluate surgical advantages and postoperative results.
Methods. In this prospective study, 110 patients scheduled for coronary artery bypass grafting were randomized into 3 groups: vein harvesting by standard continuous skin incisions (group I), conventional bridge technique (group II), and the SaphLITE retractor system (group III). Particular interest was paid to collecting intraoperative data and postoperative clinical results.
Results. The ratio of vein length to incision length was 0.89 for group I, 1.9 for group II, and 3.3 for group III. Dissection time per centimeter of vein harvested and time for wound closure were found to be 1.23 min and 0.77 min for group I, 0.89 min and 0.57 min for group II, and 0.96 min and 0.46 min for group III. No wound infection was seen in either group; conduit quality, postoperative pain, and mobilization were similar. Hematoma and edema formation were less frequent in groups I and II. The best cosmetic results were seen in the SaphLITE group.
Conclusions. Less invasive vein harvesting techniques, especially with use of the SaphLITE retractor system, yield favorable clinical results, particular with respect to cosmetic appearance. Compared to the conventional approach, the SaphLITE method is suitable for routine vein harvesting because it has fewer complications and is easy and fast to perform. Because the bridge technique does not require special instruments, it has economic advantages.
Goel P, Sankar NM, Rajan S, et al. 2000. Use of direct laryngoscope for better exposure in minimally invasive saphenous vein harvesting. Eur J Cardiothorac Surg 17(2):182-3.nGreenfield GT, Whitworth WA, Tavares LL, et al. 2001. Minimally invasive vein harvest and wound healing using the SaphLITE Retractor System. Ann Thorac Surgery 72(3):S1046-9.nHorvath KD, Gray D, Benton L, et al. 1998. Operative outcomes of minimally invasive saphenous vein harvest. Am J Surg 175(5):32-5.nFabricius AM, Oser A, Diegeler A, et al. 2000. Minimally invasive saphenous vein harvesting techniques: morphology and postoperative outcome. Ann Thorac Surg 70(2):473-8.nLutz CW, Schlensak C, Lutter G, et al. 1997. Minimal-invasive, video-assisted vein harvesting for cardiac and vascular procedures. Eur J Car-diothorac Surg 12(3):519-21.nLumsden AB, Eaves FF, Ofenloch JC, et al. 1996. Subcutaneous, videoassisted saphenous vein harvested: report of the first 30 cases. Car-diovasc Surg 39(5):386-8.nIsgro F, Weisse U, Voss B, et al. 1999. Minimally invasive saphenous vein harvesting: is there an improvement of the results with endoscopic approach? Eur J Cardiothorac Surg 16(Suppl 2):S58-60.nNewman RV, Lammle WG. 1999. Minimally invasive vein harvesting: new techniques with old tools. Ann Thorac Surg 67(2):571-2.nRinia-Feenstra M, Stooker W, de Graaf R, et al. 2000. Functional properties of the saphenous vein harvested by minimally invasive techniques. Ann Thorac Surg 69(4):1116-20.nCable DG, Dearani JA, Pfeifer EA, et al. 1998. Minimally invasive saphenous vein harvesting: endothelial integrity and early clinical results. Ann Thorac Surg 66(1):139-43.nCoppoolse R, Rees W, Krech R, et al. 1999. Routine minimal invasive vein harvesting reduces postoperative morbidity in cardiac bypass procedures. Clinical report of 1400 patients. Eur J Cardiothorac Surg 16(Suppl 2):S61-6.n