A Modified No-Touch Technique of Saphenous Vein Harvesting With a Harmonic Scalpel in OPCAB

This video was recorded in the operating room of the cardiovascular surgery department of Shanghai 10th People's Hospital in China. In this video, the authors present a modified no-touch technique of the saphenous vein harvesting and also the use of this kind of pedicle vein graft in an off-pump coronary artery bypass (CABG) procedure.

The purpose of using the no-touch technique in harvesting the saphenous vein with its surrounding tissue is to have a better patency of the graft, but the no-touch technique often takes more time when each branch of the vein must be ligated. It is also believed that the more manipulation on the vein, the more spasm that can occur. In 2017, the authors tried to harvest the saphenous vein with the harmonic scalpel, which required almost equal time as the conventional harvesting way.

The patient was a 60-year-old man. The preoperative diagnosis of this patient was coronary artery disease of triple vessel lesion.

Before positioning the patient, the saphenous vein was marked on the skin with the help of echography. The incision was made at the femoral end of the vein. Once the vein was found, the surrounding tissue was dissected 5 to 10 millimeters from the vein. A silk band was passed through beneath to lift the vein gently, which can facilitate the harvesting with the harmonic scalpel. During the harvesting, 10 millimeter of tissue around the vein was kept as a pedicle, and all the branches of the vein were ligated by the harmonic scalpel at the same time. The clips are not necessary unless the diameter of the branch is over two millimeters. Before the vein was totally harvested, the heparin was given to the patient. Thus, the authors got a half cylinder vein graft with two sides. The shape of the graft was just as a split pencil; a vein side and a tissue side could be easily identified. It is known that the over-pressure of the flushing can be harmful to the graft’s patency. So the graft was flushed with one end open without any resistance.

In this case, the authors did the proximal anastomosis of the vein graft before the internal mammary artery anastomosis for the vein graft to have an arterial pressure adaptation time before the distal anastomosis.

The torsion of a graft would be a big problem for a bypass surgery, especially for a sequential anastomosis procedure. In this case, all the anastomosis were made on the vein side, and the torsion of the graft could be entirely avoided.

This technique is now routinely used by the authors in the case of CABGs. These vein grafts show good short-term results in the patients.

Additional Resources

1. Samano N, Geijer H, Liden M, Fremes S, Bodin L, Souza D. The no-touch saphenous vein for coronary artery bypass grafting maintains a patency, after 16 years, comparable to the left internal thoracic artery: a randomized trial. J Thorac Cardiovasc Surg. 2015 Oct;150(4):880-888.
2. Souza DS, Johansson B, Bojo L, et al. Harvesting the saphenous vein with surrounding tissue for CABG provides long-term graft patency comparable to the left internal thoracic artery: results of a randomized longitudinal trial. J Thorac Cardiovasc Surg. 2006;132(2):373-378.