Does the experience of the endoscopic vein harvester matter to the quality of the vein conduit: A critical thematic literature review.

Abstract

Coronary artery bypass graft surgery remains the golden standard surgical option for multiple vessel disease. Harvesting the long saphenous vein using endoscopic vein harvesting requires advanced surgical skills dexterity, but the lack of a national standardised training programme allows for variance in the learning curve and the quality of the vein during the learning cycle is unknown. A search of bibliographic databases: CINHAL Plus, Embase, Pubmed and the Cochrane register for randomised controlled trials identified 11 articles eligible for review. The themes emerging were learning curve-associated injuries to the long saphenous vein, intimal wall remodelling of the long saphenous vein and incidence of graft patency rates. Harvesting practitioners with less than 100 cases of experience inflict more conduit injuries leading to endothelial remodelling and narrowed vein grafts at the six-month point resulting in lumen loss. Practitioners with more than 100 cases demonstrated reduced learning curve-related injuries on the conduit. Adopting a formalised structured training programme such as the Manchester Endoscopic Learning Tool has shown to reduce endothelial injury to the long saphenous vein minimising early vein graft failure during the learning cycle.