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Minimally invasive saphenous vein harvesting techniques: Morphology and postoperative outcome

ANNALS OF THORACIC SURGERY 2000年第2期70卷 473-478页

作者： Fabricius, AM Diegeler, A Doll, N Weidenbach, H Mohr, FW Herzzentrum Leipzig Klin Herzchirurg Div Pathol D-04289 Leipzig Germany

Background. Conventional saphenous vein han est is associated with numerous complications, which may be reduced by minimally invasive vein-harvesting techniques. The integrity of the venous endothelium must be guaranteed before using new saphenous vein harvesting techniques. This short-term study compared the clinical outcome of two minimally invasive techniques with the conventional technique, and compared morphology as documented by light and electron microscopy. Methods. Ninety-two patients were prospectively randomized into three groups. Two different minimally invasive techniques of greater saphenous vein harvesting were used in sixty-two patients. One used a video-assisted dissector (group A, n = 31), and one used a light-coupled retractor (group B, n = 31). Thirty patients were treated by the conventional technique (group C). Results. Incision lengths were 7.6 +/- 2.1 cm in group A and 9.3 +/- 3.2 cm in group B, as compared with 38.9 +/- 8.7 cm in the conventional group. Harvesting time was prolonged by a mean of 26% when using a minimally invasive technique. Conversion rate to the open technique was 3 of 31 (9.3%) in group A and 2 of 31 (6.2%) in group B. No wound complications were noted in group A, but one wound inflammation was seen in group B;only a mild hematoma was seen in both groups. Edge necrosis, wound separation and inflammation were noted in the conventional group. Light and electron microscopy revealed no significant denudation of the endothelial layer in groups A and B as compared with group C. Conclusions. These data show an excellent postoperative result when using the minimally invasive technique as compared with the conventional group. The safety of the technique is demonstrated by the preservation of endothelial integrity. (C) 2000 by The Society of Thoracic Surgeons.

关键词：可行性研究前瞻性研究隐静脉/病理学隐静脉/移植外科手术微创性组织和器官获取/方法血管外科手术/方法女(雌)性人类男(雄)性中年人

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Benefits of endoscopic vein harvesting

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WORLD JOURNAL OF SURGERY 2000年第9期24卷 1104-1108页

作者： Marty, B von Segesser, LK Tozzi, P Guzmann, J Frascarolo, P Muller, X Hayoz, D CHU Vaudois Univ Hosp Dept Cardiovasc Surg CH-1011 Lausanne Switzerland

The purpose of this study was to evaluate and compare the benefits of endoscopic saphenous vein harvesting (EVH) with the traditional incision technique (TIT) for coronary artery bypass grafting (CABG) in respect to the technical procedure and clinical outcome. In a prospective nonrandomized, case-matched study the greater saphenous vein was harvested for CABG in 22 patients using the endoscopic technique and in 18 patients with the traditional method. Comparisons were made for the operating time, length of incision and vein harvested, graft quality, postoperative complications, and pain assessment. Patient demographics were well matched. EVH required smaller incisions than did the TIT (10.5 +/- 6.6 vs. 31.2 +/- 7.8 cm, respectively;p < 0.0001). Harvest time and vein quality were comparable in the two groups. Total vein operating time was shorter following the endoscopic technique (60 +/- 24 vs. 100 +/- 35 minutes, respectively;p < 0.0001). EVH had fewer complications (NS), and postoperative pain was significantly less (p = 0.0034). The major advantages of endoscopic vein harvesting are a significant reduction of postoperative pain and strikingly better cosmetic results. Wound complications seem to be less frequent.

关键词：冠状动脉分流术内窥镜检查疼痛手术后/预防和控制前瞻性研究隐静脉/移植组织和器官获取/方法伤口愈合老年人女(雌)性人类男(雄)性中年人

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Comparison of traditional and subcutaneous patellar tendon harvest - A prospective study of donor site-related problems after anterior cruciate ligament reconstruction using different graft harvesting techniques

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AMERICAN JOURNAL OF SPORTS MEDICINE 2000年第3期28卷 328-335页

作者： Kartus, J Ejerhed, L Sernert, N Brandsson, S Karlsson, J Norra Alvsborh Hosp Dept Orthopaed SE-46185 Trollhattan Sweden Sahlgrens Univ Hosp Dept Orthopaed S-41345 Gothenburg Sweden

Our goal was to compare the results after anterior cruciate ligament reconstruction using either the traditional one-incision or the subcutaneous two-incision technique to harvest the central third of the patellar tendon, particularly concerning disturbances in anterior knee sensitivity and the patient's ability to walk on his or her knees. One surgeon performed anterior cruciate ligament reconstruction on 124 patients with unilateral ruptures and no history of previous incisions in the anterior knee region, The traditional one-incision graft harvesting technique was used in 58 patients and the subcutaneous two-incision technique was used in 66 patients. At 2 years, the International Knee Documentation Committee classification, Lysholm score, arthrometry side-to-side difference, and single-legged hop test showed no significant differences between groups. The area of insensitivity was a median of 24 cm(2) in the traditional harvest group and 0 cm(2) in the subcutaneous harvest group, The patients with subcutaneous harvest had a tendency toward fewer problems during walking on their knees than did the patients with traditional harvest. Our conclusion is that the subcutaneous two-incision graft harvesting technique caused less disturbance in anterior knee sensitivity and a tendency of less discomfort during walking on one's knees than the traditional one-incision technique.

关键词：前交叉韧带/外科学卡方分布关节不稳定性/病理生理学关节不稳定性/外科学膝关节/病理生理学膝关节/外科学髌骨前瞻性研究活动范围关节修复外科手术/方法统计学非参数腱/移植组织和器官获取/方法移植自体治疗结果青少年成年人女(雌)性人类中年人

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Microkeratome-based limbal harvester for limbal stem cell transplantation: Preliminary studies

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AMERICAN JOURNAL OF OPHTHALMOLOGY 2001年第3期131卷 377-378页

作者： Chuck, RS Behrens, A McDonnell, PJ Univ Calif Irvine Dept Ophthalmol Irvine CA 92697 USA Univ So Calif Doheny Eye Inst Dept Ophthalmol Los Angeles CA USA

PURPOSE: To develop a mechanical device to perform limbal transplantation. This procedure is a valuable surgical technique for management of limbal stem cell deficiency. However, the freehand dissection to obtain donor tissue is laborious and time-consuming. METHODS: A manual microkeratome (LSK One;Moria/Microtech, Doylestown, Pennsylvania) using a redesigned head (200 mum thickness, 16-mm blade) was used to create partial thickness corneoscleral caps from human donor globes. RESULTS: Corneoscleral caps obtained from human donor globes included a ring of approximately 1 mm of perilimbal sclera in contiguity to the cornea. Scanning electron microscopy showed a smooth cut surface with some chatter at the margins. CONCLUSION: This instrument ensures an effective and straightforward method to dissect the area where stem cells have been indirectly localized. (Am J Ophthalmol 2001;131:377-378. (C) 2001 by Elsevier Science Inc. All rights reserved.).

关键词：细胞移植角膜疾病/外科学上皮细胞/移植上皮细胞/超微结构角膜缘/细胞学显微镜检查电子扫描眼外科手术/仪器和设备干细胞移植干细胞/超微结构组织和器官获取/方法人类

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Lung transplantation from non-heart-beating donors

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TRANSPLANTATION PROCEEDINGS 2000年第2期32卷 279-280页

作者： Shimada, K Kondo, T Okada, Y Matsumura, Y Oyaizu, T Handa, M Ichinose, T Sado, T Fujimura, S Tohoku Univ Inst Dev Aging & Canc Dept Thorac Surg Aoba Ku Sendai Miyagi 9808575 Japan Sendai Kosei Hosp Sendai Miyagi Japan Isawa Prefectual Hosp Mizusawa Japan

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Endoscopic versus open saphenous vein harvest: The effect on postoperative outcomes

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ANNALS OF THORACIC SURGERY 1999年第6期68卷 2107-2110页

作者： Hayward, TZ Hey, LA Newman, LL Duhaylongsod, FG Hayward, KA Lowe, JE Smith, PK Duke Univ Med Ctr Dept Surg Durham NC 27710 USA

Background.. Endoscopic vein harvest (EVH) has been promoted as a possible solution to the wound complications, incisional pain, and prolonged convalesce associated with open vein harvesting (OVH). The purpose of this study was to objectively compare the two techniques. Methods. One hundred patients were prospectively randomized to EVH or OVH. Primary outcomes were wound complications, pain (Medical Outcomes Study Pain Survey), and general health (SF-12). Secondary outcomes were operative times and patient preferences. Patients were assessed at hospital discharge, 3, and 6 weeks postdischarge. Results. No significant differences were detected in the primary outcomes: leg infection (p = 0.75), incisional pain (p = 0.74), physical health (p = 0.84), mental health (p = 0.47), and postoperative length of stay (p = 0.74). However, patient preference for EVH was highly significant (p < 0.01). Conclusions. EVH does not demonstrate significant differences compared with OVH. This, coupled with higher operating room costs, should limit its use until clinical benefit is shown. However, strong patient preference and demand for EVH overshadow equivocal clinical outcomes. (C) 1999 by The Society of Thoracic Surgeons.

关键词：冠状动脉分流术内窥镜检查疼痛手术后病人满意度手术后并发症前瞻性研究隐静脉/移植外科伤口感染组织和器官获取/方法老年人女(雌)性人类男(雄)性中年人

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Reduction in wound morbidity rates following endoscopic saphenous vein harvest

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ANNALS OF VASCULAR SURGERY 2001年第1期15卷 104-109页

作者： Illig, KA Rhodes, JM Sternbach, Y Shortell, CK Davies, MG Green, RM Univ Rochester Med Ctr Div Vasc Surg Rochester NY 14642 USA

To determine whether less-invasive saphenous vein harvest reduces morbidity in patients undergoing infrainguinal bypass, we retrospectively compared 61 patients undergoing endoscopic harvest (ENDO) with 49 patients undergoing conventional harvest (OPEN) over the past 13 months. Patients were classified as potential short-stay if adjunctive suprainguinal inflow procedures or foot amputations were not required and the patient was ambulatory prior to elective operation. Mean endoscopic harvest time was 50 +/- 18 (range 25-90) min, and no more than three 5-cm incisions were required in 87% of cases. Szilagyi class II or III wound complications occurred after 1 of the 61 (2%) ENDO procedures and 7 of the 49 (14%) OPEN (p < 0.01), and any complication occurred in 13 (21%) vs. 25 (51%) of ENDO and OPEN procedures, respectively (p < 0.002). Mean postoperative length of stay was significantly shorter in the 24 short-stay ENDO (4.0 +/- 2.4 days) vs. 25 short-stay OPEN (6.0 +/- 3.2 days) patients (p < 0.02). Thirty-day patency rates between the two groups were not different. Endoscopic saphenous vein harvest is associated with a reduced incidence of serious wound complications and, in selected patients, shortened postoperative hospital stay.

关键词：血肿/病因学腿/血液供给住院时间淋巴囊肿/病因学手术后并发症回顾性研究隐静脉/移植外科伤口感染组织和器官获取/方法血管未闭血管外科手术/方法伤口愈合老年人人类

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Laparoscopic living donor nephrectomy:: University of Liege experience

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TRANSPLANTATION PROCEEDINGS 2000年第2期32卷 486-487页

作者： Detry, O Hamoir, E Defechereux, T Bonnet, P Honoré, P Meurisse, M Univ Liege Dept Surg & Transplantat B-4000 Liege Belgium

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Modified technique of delivering solutions to rat coronary arteries in the transplant setting

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TRANSPLANTATION PROCEEDINGS 1999年第8期31卷 3255-3256页

作者： Nourani, F Laufer, G Hollensteiner, H Bergmeister, H Buschle, M Khazen, C Ankersmit, J Traxler, H Wolner, E Losert, U Kocher, AA Univ Vienna Dept Cardiothorac Surg Vienna Austria Univ Vienna Ctr Biomed Res Vienna Austria Univ Vienna Dept Anat 1 Vienna Austria

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Arterial reconstruction in hepatic and-pancreatic allograft transplantation following multi-organ procurement

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TRANSPLANTATION PROCEEDINGS 2000年第1期32卷 109-110页

作者： Hesse, UJ Troisi, R Maene, L de Hemptinne, B Pattyn, P Lameire, N State Univ Ghent Hosp Dept Surg B-9000 Ghent Belgium State Univ Ghent Hosp Dept Nephrol B-9000 Ghent Belgium

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