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.

Keywords: Coronary artery bypass; Endoscopic vein harvesting; Learning curve; Saphenous vein.

Fig. 1

The effects of nitric oxide. Nitric oxide (NO) is an important vasodilator synthesised from L-arginine via endothelial nitrogen oxide synthase (eNOS). NO activates guanylyl cyclise, leading to elevated concentrations of cyclic guanosine monophosphate (cGMP) and the downstream activation of cGMP-dependent protein kinase. This enzyme mediates a significant reduction in intracellular Ca²⁺concentration and decreased vascular tone, resulting in vascular smooth muscle relaxation. Simultaneously, NO inhibits the aggregation of platelets, vascular smooth muscle cell proliferation, thrombus formation and ameliorates the adhesion capabilities of leukocytes