EJCTS Click here for details of sales representative
HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS
QUICK SEARCH:   [advanced]


     

This Article
Right arrow Abstract Freely available
Right arrow Full Text (PDF)
Right arrow Alert me when this article is cited
Right arrow Alert me if a correction is posted
Right arrow Citation Map
Services
Right arrow Email this article to a friend
Right arrow Similar articles in this journal
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Add to Personal Folders
Right arrow Download to citation manager
Right arrow Author home page(s):
Pankaj Goel
Kotturathu Mammen Cherian
Right arrow Permission Requests
Citing Articles
Right arrow Citing Articles via HighWire
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by Goel, P.
Right arrow Articles by Cherian, K. M.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Goel, P.
Right arrow Articles by Cherian, K. M.

Eur J Cardiothorac Surg 2000;17:182-183
© 2000 Elsevier Science NL

How to do it

Use of direct laryngoscope for better exposure in minimally invasive saphenous vein harvesting

Pankaj Goel, Nainar Madhu Sankar, Sethurathinam Rajan, Kotturathu Mammen Cherian

Institute of Cardiovascular Diseases, Madras Medical Mission, Mogappair, Chennai 600 050, India

Corresponding author. Tel.: +91-44-625-9801; fax: +91-44-625-9919
e-mail: mmmbits{at}giasmd01.vsnl.net.in


   Abstract
Top
 Abstract
1. Introduction
 2. Technique
 3. Comment
 References
 
A direct laryngoscope-assisted technique of saphenous vein harvesting by tunnelling method is described. This technique provides better exposure through small incisions, thus reducing the chances of trauma to the vein due to excessive handling. The equipment used is inexpensive and readily available.

Key Words: Minimally invasive saphenous vein harvesting • Cosmetic incision


   1. Introduction
Top
 Abstract
 1. Introduction
2. Technique
 3. Comment
 References
 
In this era of minimally invasive cardiac surgery, saphenous vein harvesting by minimally invasive methods is also becoming popular [1,2]. The main argument against the use of these methods is the inadequate exposure leading to excessive vein handling and compromised vein graft. We describe a modified technique of saphenous vein harvesting by the tunnelling method using the direct laryngoscope. The equipment used is reusable, inexpensive and readily available. This technique provides good exposure, thus, reducing the vein handling and consequent trauma.


   2. Technique
Top
 Abstract
 1. Introduction
 2. Technique
3. Comment
 References
 
The tunnelling technique involves multiple small transverse incisions starting in the groin. The saphenous vein is dissected down in a tunnel, the Mayo vein stripper (Johnson & Johnson) is then introduced and the vein is then taken out of the distal incision. The tributaries are clipped using Ligaclip. The process is repeated until the desired length of vein is obtained (Fig. 1). We found that the conventional lighting and retraction were cumbersome and did not provide good exposure within the tunnel. This increased the chances of vein handling and damage, thus compromising the quality of vein graft.



View larger version (96K):
[in this window]
[in a new window]
  		Fig. 1. Cosmetic result obtained after saphenous vein harvesting by the tunnelling method.

 
We now use an ETO gas sterilized direct laryngoscope with the adult size blade for this purpose. After preliminary dissection around the saphenous vein, the laryngoscope blade is introduced through the skin incision into the subcutaneous tunnel. As seen in Fig. 2 this not only lights up the operative field, but also acts as a convenient retractor. This provides excellent exposure of the vein and its tributaries and reduces vein handling and trauma. Until now we have used this technique in 110 patients with satisfactory results.



View larger version (36K):
[in this window]
[in a new window]
  		Fig. 2. Schematic drawing showing the use of direct laryngoscope in stripping of saphenous vein from the left thigh.

 

   3. Comment
Top
 Abstract
 1. Introduction
 2. Technique
 3. Comment
References
 
The tunnelling technique for saphenous vein harvesting not only produces cosmetically better results but also has a lower incidence of wound infection than the traditional open harvest technique [3,4]. O'Regan and colleagues have shown that harvesting the saphenous vein with the Mayo stripper does not compromise vascular reactivity or long term patency of the venous conduit [2]. The main argument, against the use of this technique has been the risk of excessive vein handling and damage. This risk is a consequence of limited exposure and inadequate light within the tunnel. The laryngoscope technique described here provides good exposure and light within the operative field. The equipment used is reusable, inexpensive and readily available. We are also in the process of modifying the laryngoscope blade so that it may be used for still smaller incisions.


   References
Top
 Abstract
 1. Introduction
 2. Technique
 3. Comment
 References
 

  1. Dimitri W.R., West I.E., Williams B.T. A quick and atraumatic method of autologous vein harvesting using subcutaneous extra luminal dissector. J Cardiovasc Surg 1987;28:103-111.[Medline]
  2. O'Regan D.J., Borland J.A.A., Chester A.H., Pennell D.J., Yacoub M., Pepper J.R. Assessment of human long saphenous vein function with minimally invasive harvesting with the Mayo stripper. Eur J Cardio-thorac Surg 1997;12:428-435.[Abstract]
  3. Tran H.M., Paterson H.S., Meldrum-Hanna W., Chard R.B. Tunnelling versus open harvest technique in obtaining venous conduits for coronary bypass surgery. Eur J Cardio-thorac Surg 1998;14:602-606.[Abstract/Free Full Text]
  4. Meldrum-Hanna W., Ross D., Johnson D., Seal D. An improved technique for long saphenous vein harvesting for coronary revascularisation. Ann Thorac Surg 1986;42:90-92.[Abstract]
Received October 4, 1999; received in revised form December 7, 1999; accepted December 21, 1999.




This article has been cited by other articles:


Home page
 Ann. Thorac. Surg.Home page
S. Wang, H. Tang, V. Wilkinson, T. Lukat, E. T. Gelfand, A. Koshal, D. L. Modry, J. C. Mullen, C. Hao, and B. A. Finegan
Saphenous Vein Harvest With SaphLITE System Versus Conventional Technique: A Prospective, Randomized Study
Ann. Thorac. Surg., June 1, 2005; 79(6): 2018 - 2023.
[Abstract] [Full Text] [PDF]

Home page
 Eur. J. Cardiothorac. Surg.Home page
E. A. Black, R.N. Karen Campbell, K. M. Channon, C. Ratnatunga, and R. Pillai
Minimally invasive vein harvesting significantly reduces pain and wound morbidity
Eur. J. Cardiothorac. Surg., September 1, 2002; 22(3): 381 - 386.
[Abstract] [Full Text] [PDF]

Home page
 Asian Cardiovasc. Thorac. Ann.Home page
V. Agarwal, S. K Agarwal, N. K Gupta, and A. K Srivastava
Minimally Invasive Saphenous Vein Harvesting Using Conventional Instruments
Asian Cardiovasc Thorac Ann, September 1, 2001; 9(3): 246 - 247.
[Abstract] [Full Text] [PDF]

Home page
 Ann. Thorac. Surg.Home page
E. A. Black, T. J. Guzik, N. E.J. West, K. Campbell, R. Pillai, C. Ratnatunga, and K. M. Channon
Minimally invasive saphenous vein harvesting: effects on endothelial and smooth muscle function
Ann. Thorac. Surg., May 1, 2001; 71(5): 1503 - 1507.
[Abstract] [Full Text] [PDF]

This Article
Right arrow Abstract Freely available
Right arrow Full Text (PDF)
Right arrow Alert me when this article is cited
Right arrow Alert me if a correction is posted
Right arrow Citation Map
Services
Right arrow Email this article to a friend
Right arrow Similar articles in this journal
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Add to Personal Folders
Right arrow Download to citation manager
Right arrow Author home page(s):
Pankaj Goel
Kotturathu Mammen Cherian
Right arrow Permission Requests
Citing Articles
Right arrow Citing Articles via HighWire
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by Goel, P.
Right arrow Articles by Cherian, K. M.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Goel, P.
Right arrow Articles by Cherian, K. M.

HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS
ANN THORAC SURG ASIAN CARDIOVASC THORAC ANN EUR J CARDIOTHORAC SURG
J THORAC CARDIOVASC SURG ICVTS ALL CTSNet JOURNALS