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Ann Thorac Surg 1998;66:1626-1631
© 1998 The Society of Thoracic Surgeons

Clinical experience with the video-assisted saphenectomy procedure for coronary bypass operations

^a Division of Thoracic and Cardiovascular Surgery, University of Louisville, Louisville, Kentucky, USA

Accepted for publication May 13, 1998.

Address reprint requests to Dr Spence, Division Thoracic and Cardiovascular Surgery, University of Louisville, 201 Abraham Flexner Way, Suite 1200, Louisville, KY 40202

Background. Leg wound complications after saphenectomy are frequent after coronary bypass operations and have a detrimental effect on postoperative quality of life and treatment cost. To reduce morbidity, we evaluated a new technique of video-assisted vein harvest.

Methods. Between March 1996 and October 1996, 50 patients had video-assisted saphenectomy (VAS) and 40 patients had the standard open technique (control group). An additional 13 patients had both procedures (hybrid group). Level of pain, edema, and wound complications were evaluated at discharge and at 2, 4, and 6 weeks postoperatively.

Results. The mean operating time for VAS patients was slightly higher than for control (60.6 ± 24.7 minutes versus 53.2 ± 21.1 minutes; p > 0.05). The average incision length in VAS patients was 13.8 ± 8.8 cm for an average of 3.3 grafts per patient. Three VAS procedures were aborted, two because of time constraints, and one because of bleeding, and a segment of vein was lost to injury. The VAS group had considerably less early postoperative pain than the control group (1.7 ± 1.2 versus 4.1 ± 1.4 [1 = mild, 10 = severe]; p < 0.005) and edema was similar for both groups. Patients in the hybrid group reported less pain in the VAS-operated leg. Serious wound infection occurred in 4 patients, with 2 patients in the control group requiring reoperation for drainage and flap reconstruction.

Conclusions. Based on this initial experience, VAS harvesting, although initially more time consuming, is a rapidly mastered technique, results in shorter overall incision length, and is associated with considerably less postoperative pain than the standard open technique.

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