New Endoscopic Procedure Means Faster Recovery, Fewer Complications For Vascular Surgical Patients

August 07, 2000

Surgeons at Strong Memorial Hospital of the University of Rochester Medical Center are performing an endoscopic technique to harvest veins for leg-bypass-grafting surgery. The new procedure, using a miniature camera to view blood vessels inside of the leg, eliminates the long incision associated with the traditional process and results in faster recovery for patients.

When a patient undergoes bypass surgery to correct a blockage such as those found in the leg or the heart, the vein used for grafting is usually removed from the leg. The incision leaves an often painful surgical site that can be at risk for infection and frequently results in a long scar, says vascular surgeon Karl Illig, M.D. Many patients claim that it is that incision, not the one resulting from the graft itself, that is most painful during recovery.

With the new endoscopic procedure, two to four incisions are made in the leg, each about 3 inches long, for insertion of the endoscopic surgical instruments. Minute camera equipment - transmitting an image to a video monitor - allows the surgeon to view the inside of the leg and locate and remove the vein to be used for grafting.

"This is much less invasive than the traditional or 'open' surgical procedure, which requires a long incision that may run the length of the leg in order to remove the vein for bypass," Illig says. "Using the endoscope to guide us, we can accomplish the same mission with a shorter, less painful recovery time and a decreased chance of infection."

The operation takes the same amount of time as the traditional technique - about two hours, including the bypass procedure. Patients experience significantly less pain postoperatively, and the incidence of serious wound complications is reduced from 16 percent to 2 percent. For patients who have no other issues other than the bypass itself, postoperative length of stay has been reduced from about 5.5 days to 3.7 days.

Illig and colleagues Yaron Sternbach, M.D., Cynthia Shortell, M.D., and Jeffrey Rhodes, M.D., have performed more than 60 endoscopic vein-harvesting procedures at Strong Memorial Hospital.

Vein-harvesting for leg bypass is one of the most frequently performed procedures in the United States today, about 100,000 cases each year. Nearly 400 are done annually at Strong Memorial Hospital. Wound complications, when they occur, can add between $1,000 and $18,000 in extra expense per case and, depending on the problem, can lead to limb loss or death.

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