Objective

Endoscopic harvest of the saphenous vein (EVH) is recommended in coronary surgery to limit the complications of open vein harvest (OVH). It is a procedure normally performed by surgical care practitioners. Given the benefits that can be yielded in terms of developing skills of minimally invasive surgery, should endoscopic vein harvest be a part of formal cardiothoracic surgical training? We present the experience of cardiothoracic trainees in training in EVH.

Methods

A trainee underwent supervised training in EVH over a 2-week period. A prerequisite to training was proficiency in OVH. After reading literature on the technique and observing EVH procedures, there was a period of initial training on a model, under the guidance of a clinical trainer. After being assessed by the trainer, training then took place in the operating theatre under supervision. Patients were reviewed prior to discharge by the operating trainee and any complications were documented.

Results

Between May and October 2015, 52 patients underwent EVH. The first 12 procedures were performed under direct supervision, after which competence in performing EVH independently was achieved. Median harvest times for 2 and 3 standard lengths of vein were 48 minutes (range 44-81 minutes) and 60 minutes (range 58-94 minutes) respectively. The vein was usable in all cases and there was only 1 conversion to OVH. No patients suffered wound infection, haematoma in the leg or early graft failure.

Conclusion

We have demonstrated that, in addition to benefit to patients, the skills of EVH can be safely learnt and performed by junior trainees. These skills are invaluable to current day cardiothoracic trainees and can be applied to other forms of minimally invasive surgery within the specialty. Given the increase in minimally invasive cardiothoracic surgery, we therefore believe EVH training should be part of the curriculum.