Since its introduction in 1996, the video-assisted
endoscopic method of saphenous harvesting has
gained significant popularity in the coronary
surgery.[
4] Furthermore, by 2008, approximately 70%
of saphenous harvesting in the UK was performed
using this technique.[
8] This rapid dissemination
can be attributed to numerous benefits associated
with endoscopic saphenous harvesting, as extensively
documented in the literature.[
8] These advantages
include improved wound healing, reduced risk of
infection, and shorter hospital stays. On the flip side,
it is worth noting that some randomized controlled
trials have reported poor cardiac outcomes associated
with EVH compared to open saphenous harvest.
These findings have raised certain concerns within
the cardiac surgery community.[
9,
10]
Consistent with existing literature, our study
demonstrated a significant reduction in wound dressing
time and faster wound healing in the endoscopic
harvest group.[11-13] Furthermore, the open group
exhibited a significantly higher incidence of wound site
discharge and requirement for debridement compared
to the EVH group. However, contrary to the findings
reported in the existing literature, we did not observe
a statistically significant difference between the two
groups regarding wound infection.[12,13] It is essential
to acknowledge that although we did not experience
any case of wound site infection in the EVH group,
the limited sample size in our study might have
contributed to the lack of a significant difference
in wound infection rates. Additionally, it is worth
highlighting that one patient in the open surgery
group developed sepsis as a consequence of wound
infection, underscoring the criticality of meticulous
wound management in surgical procedures.
In our study, we rigorously implemented the
enhanced recovery after surgery (ERAS) protocol,
which is designed to optimize patient care and reduce
hospitalization duration in both the endoscopic and
open groups. Our efforts aimed to minimize hospital
stays, particularly for patients undergoing multivessel
coronary bypass surgery. This approach aligns with
previous studies that have shown the benefits of shorter
hospitalization periods for patients following ERAS protocols.[14,15] Remarkably, the EVH group exhibited
significantly shorter hospitalization durations and
dressing times, suggesting that endoscopic harvesting
is not only more cost-effective but also facilitates
faster patient recovery. These findings underscore the
potential advantages of adopting endoscopic techniques
in saphenous harvesting for coronary bypass surgery.
Our study findings align with existing literature
in terms of quality of life outcomes. Specifically,
we observed consistent results regarding pain levels
in the postoperative period, where the EVH group
exhibited significantly lower pain in the saphenous
harvest area compared to the open group. Moreover,
the incidence of keloid scar formation at the wound
site was significantly lower in the EVH group. These
outcomes highlight the clear superiority of endoscopic
saphenous harvesting in terms of pain management
and minimizing keloid scar formation, which are
important factors influencing the quality of life for
patients undergoing this procedure.
Neither group exhibited any occurrences of graft
thrombosis, bleeding from graft branches, or structural
deterioration in the graft, which are considered
important graft-related adverse event outcome
parameters. These findings suggest that the technique
of saphenous vein harvesting, whether endoscopic or
open, can be safely employed with regard to cardiac
considerations.
While the study holds significant value, there are
two limitations that need to be acknowledged and
addressed: the retrospective design and the absence
of long-term results. Despite these limitations, the
study offers a comprehensive and insightful real-world
view of endoscopic harvesting, particularly within a
region where such techniques are rarely employed.
Additionally, it is crucial to emphasize that the
statistical analysis yields a substantial power level of
over 95% for wound discharge and pain assessment.
This high statistical power underscores the robustness
and reliability of the study's findings in these aspects.
In conclusion, our study compared the outcomes
of endoscopic and open saphenous vein harvesting
methods. The EVH group demonstrated favorable
wound site outcomes, including faster healing,
reduced dressing time, and lower incidence of wound
discharge. Although no significant difference was
found in wound infection rates, the limited sample
size may have influenced this result. Both groups had
comparable recovery outcomes, likely due to adherence to the ERAS protocol. Endoscopic harvesting
showed superior quality of life outcomes, with lower
postoperative pain and fewer keloid scars. Importantly,
neither group experienced cardiac complications, such
as graft thrombosis or bleeding. These findings support
the safety and benefits of EVH, contributing to the
existing knowledge and guiding surgical decisionmaking
for optimal patient outcomes.
Ethics Committee Approval: The study protocol was
approved by the Koşuyolu High Specialization Hospital
Ethics Committee (date: 04.07.2023, no: 202311l/703). The
study was conducted in accordance with the principles of the
Declaration of Helsinki.
Patient Consent for Publication: A written informed
consent was obtained from each patient.
Data Sharing Statement: The data that support the
findings of this study are available from the corresponding
author upon reasonable request.
Author Contributions: Concept, design, literature
review, writing the article: M.M.O.; Control, supervision:
M.A., T.O.; Data collection: A.M.O.; Materials: H.H.;
Critical review: K.K.
Conflict of Interest: The authors declared no conflicts
of interest with respect to the authorship and/or publication
of this article.
Funding: The authors received no financial support for
the research and/or authorship of this article.