A comprehensive review on learning curve associated problems in endoscopic vein harvesting and the requirement for a standardised training programme

Abstract

Endoscopic vein harvesting is becoming one of the most favourable vein harvesting techniques in multiple bypass coronary surgery, due to its short term post-operative benefits with high patient satisfaction. However, long-term graft patency has been both supported and questioned in the literature. Graft failure can be affected by harvesting methods and operator’s experience. Endoscopic vein harvesting is associated with a learning curve period, during which the incidence of vein trauma is high due to unfamiliarity with the surgical technique. There is a paucity of structured learning tools for novice practitioners, meaning that training differs significantly between hospital centres. Inconsistent training methods can lead to poor surgical technique, which can have a significant impact on vein quality and stress level of the practitioner. In turn, this can lead to increased postoperative complications and longer surgical duration. The main aim of this literature review is to understand the impact of the learning curve on the vein conduit and whether there is a requirement for a standardised training programme for the novice practitioners.

Study Comparing Vein Integrity and Clinical Outcomes in Open Vein Harvesting and 2 Types of Endoscopic Vein Harvesting for Coronary Artery Bypass Grafting

“…Repeat angina and reintervention in patients in this study were due mainly to grafting technique and technical error,27,28 poor target-artery quality,11 progression of native coronary artery diseases,8 and previous stent blockage after CABG. Although the importance of grafting technique is highlighted by our findings, we did not observe significant intraoperator effects on MACE outcomes.…”

Patient Satisfaction and Clinical Complications after Endoscopic or Surgical Saphenous Vein Harvesting

“…It is known that vein graft quality depends on technical experience of the harvester. 6,12 The whole training process could be time consuming but is an essential element of obtaining a good quality vein conduit for better clinical outcomes. 6 Obviously, input costs of EVH compared with SVH are higher, but the final cost-benefit calculation presented recoverability of costs, so that EVH is a cost-effective alternative to SVH.…”

“…6,12 The whole training process could be time consuming but is an essential element of obtaining a good quality vein conduit for better clinical outcomes. 6 Obviously, input costs of EVH compared with SVH are higher, but the final cost-benefit calculation presented recoverability of costs, so that EVH is a cost-effective alternative to SVH. 3,13,14 Endothelial function is a determinant of long-term graft patency and late vein graft failure.…”

“…To make the clinical-operative baseline characteristics between the patients' groups, similar EVH and SHV were undertaken by a member of the EVH team consisting of two surgeons and two physician assistants with appropriate training. 6 All patients underwent a follow-up examination after 7 days.…”

Endoscopic radial artery harvesting for coronary artery bypass grafting

“…ERAH was also found to take a longer duration as compared to ORAH with an associated steep learning curve in inexperienced hands [36] . The reported learning curve for endoscopic harvest ranges from 5 to 30 cases [37] . Although, Kiaii et al [38] found that the endoscopic approach requires a significantly lower harvest time (36.5 ± 9.4 min) compared to the open approach (57.7 ± 9.4 min) when performed by a surgeon adequately experienced in endoscopic harvest.…”