Does the introduction of a comprehensive structured training programme for endoscopic vein harvesting improve conduit quality? A multicentre pilot study

Abstract

OBJECTIVES Endoscopic vein harvesting is one of the most popular minimally invasive vein-harvesting techniques for coronary artery bypass graft surgery. It is associated with improved cosmetic outcome and fewer wound-related problems compared with the conventional open technique. However, its efficacy with regard to conduit damage and long-term patency has recently been questioned. Learning curve-associated trauma to the vein has a major impact on vein quality and the incidence of graft failure post-surgery. In an attempt to address this problem, we have devised and tested a learning tool termed Manchester Endoscopic Learning Tool (MELT). In this study, we compare vein quality following MELT training with standard recommended training. METHODS Fourteen practitioners across seven UK centres were enrolled into the study. Practitioners were categorized into two groups receiving MELT or standard training. Data were collected prospectively from the first eight vein retrievals per operator following training. A total of n = 112 vein-harvesting procedures were included in the study. RESULTS Veins harvested by MELT practitioners had fewer small avulsions (P <0.001), required fewer repairs (P <0.001) and experienced a lower incidence of bruising (P <0.001) than veins obtained by practitioners receiving standard training. The incidence of very short side branches requiring repair was also significantly reduced (P <0.001) in the MELT group compared with standard training. CONCLUSIONS Our formalized training programme consistently minimizes vein trauma resulting in better-quality conduits when compared with the current standard training. Exposure of surgical practitioners to the structured curriculum during their endoscopic vein harvesting training will enhance their learning and lead to better-quality conduits. This is likely to impart clinical benefit post-surgery.