eComment: Minimally invasive endoscope-enhanced venous conduit harvesting techniques

We would like to make some comments on the best evidence topic presented by Tennyson and collaborators, reporting whether (in patients undergoing coronary revascularization) endoscopic vein harvesting technique is superior to the conventional (open) approach [1].

A concern about wound morbidity associated with the conventional technique of saphenous vein harvesting has led to the development of a variety of minimally invasive techniques [2]. The endoscopic approach became popular because it offers better cosmetic results due to a shorter incision length than in conventional approach, and as a method that could evidently decrease the incidence of postoperative pain and infection, and reduce the costs of associated health care.

Several studies were taken into consideration within this topic to compare the endoscopic technique with the open harvesting technique. We think that the impossibility to consider the results according to the exact harvesting device is one of the limitations of this study. Any conduit harvesting device available on the market follows almost the same less invasive (endoscopy-enhanced) preparation concept, but the harvesting technique, the technical characteristics of the device, the working conditions and supposedly the quality of the harvested veins are not the same. Minimally invasive conduit harvesting techniques are evolving and probably will ever do so because of increasing attractiveness, hospital interests, industrial influence, etc. But one thing is clear: smarter harvesting solutions/techniques are necessary to allow harvesting venous conduits of a quality comparable to those prepared in a conventional way, as the number one criterion for comparison has to be the avoidance of conduit quality alteration [3].

A biased patient satisfaction, difficult-to-measure postoperative pain and scar will certainly remain important issues. Further studies on a larger group of patients will probably be helpful in revealing the risk of perioperative endothelial damage. Mid-term and long-term graft patency results should not be overshadowed by aesthetic, economic or other reasons, thus enabling us to identify, really ‘is it safe to perform endoscopic vein harvest or not?’.

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