Understanding 'Endoscopic Vessel Harvest' - A Minimally Invasive approach for conduit harvesting during CABG

Coronary Artery Bypass Grafting (CABG) requires the removal of a Vein or an Artery from one part of the body to be used as a 'conduit' for bypassing the blocked arteries of the Heart. The number of blockages in the Heart decides the number of bypasses required, which in turn dictates the length of the conduit (Vein or Artery) be harvested. Usually, the surgeon removes either the vein from the leg (Saphenous Vein) or an artery from the hand (Radial Artery). The incision used for Vein harvesting is usually considered the longest incision in any surgery (i.e. the entire length of the leg) and due to its length, often results in poor healing, swelling of the leg and is often cosmetically unacceptable. Radial Artery harvesting requires an incision along the full length of the forearm and is thus cosmetically unacceptable too.

Endoscopic Harvesting of these conduits (Saphenous Vein or the Radial Artery) is a very safe procedure that is accepted worldwide. Any conduit required for a bypass has to be free of damage and of adequate length so that the surgeon can complete the procedure. This requires the conduit to be harvested under vision, using a low-temperature source for coagulating (clotting) the small blood vessels, and a permanent seal for the branches of the conduit. Hence, specialized equipment is necessary for this procedure that is not normally available in a cardiac operation theatres. This includes a Laparoscopy Trolley, with a good quality camera (HD), CO2 Insufflator, monitor and an energy source like a Harmonic Scalpel or a Ligasure Cautery. In addition, one also needs a harvesting set of instruments (reusable or disposable) to actually perform the procedure. Naturally, this impacts the cost of the surgery and an endoscopic harvest costs about Rs 25000-30000 more than the normal harvest.