Open Harvesting Research Articles

Arthroscopic Shaver-based Harvest of Minced Cartilage Results in Reduced Chondrocyte Viability and Reduced Quality of Cartilaginous Repair Tissue Compared With Open Harvest and Conventional Fragmentation

To characterize and compare the quality of regenerative cartilage tissue (ReCT) after conventional minced cartilage (CMC) and arthroscopic minced cartilage (AMC), in terms of cell viability, gene expression, and matrix synthesis and to investigate the influence of different shaver types. Chondral tissue was harvested from the knees of 8 porcine donors. Porcine specimens were euthanized one day before harvest. AMC was created with 2 shaver blades in 2 operating modes (oscillating vs forward) and compared with a scalpel-fragmented CMC control. Before histologic analysis, 50% of the tissue was digested to prevent dedifferentiation of chondrocytes to fibroblasts. Cells were cultured and analyzed for cell viability, gene expression of cartilage-specific markers (aggrecan [ACAN], collagen type II, alpha1 [COL2A1], collagen type I, alpha1 [COL1A1], fibronectin-1 [FN1]), and matrix synthesis (Alcian-blue). AMC tissue contained fewer viable chondrocytes (41%-54% vs 91%; P= .001-.048) compared with CMC. After culture, CMC showed greater expressions of ACAN (27 virtual copy numbers [VCN]/housekeeping gene) and COL2A1 (30 VCN) compared with AMC (ACAN 2-9 VCN, COL2A1 2-7 VCN, P= .001-.039). AMC presented greater expressions of COL1A1 (9-21 VCN) and FN1 (12-17 VCN) than CMC (1 and 6 VCN, P= .001-.050). The signal intensity of the cartilage matrix formed by CMC (86/mm2) was greater than by AMC (7-10 mm2, P= .001-.032). CMC contained high numbers of viable chondrocytes, resulting in high-quality, hyaline-like ReCT. In contrast, AMC showed impaired chondrocyte quantity and viability, showing greater expressions of fibroblast markers and a decreased formation of mature cartilage matrix in porcine samples. The high chondrogenic potential of CMC to form hyaline-like ReCT was not confirmed for AMC. On the basis of our findings, arthroscopic harvest of minced cartilage leads to reduced chondrocyte viability and ReCT quality. Accordingly, CMC and AMC cannot be regarded as synonymous techniques, as arthroscopic techniques seem to be less efficacious.

Interpretation on Expert systematic review on the choice of conduits for coronary artery bypass grafting endorsed by the European Association for Cardio-Thoracic Surgery and the Society of Thoracic Surgeons in 2023

Expert systematic review on the choice of conduits for coronary artery bypass grafting: endorsed by the European Association for Cardio-Thoracic Surgery and the Society of Thoracic Surgeons published in 2023 made recommendations for the selection of bypass vessels. The left internal thoracic artery-anterior descending branch anastomosis represents the accepted gold standard. Radial artery could achieve a better long-term patency rate and a reduction in adverse cardiac events compared to the great saphenous vein. Radial artery graft using an open harvesting method should be chosen to graft the target vessel with low competitive coronary flow, with the use of vasodilators for the first year. There was no clear evidence of better patency for the right internal thoracic artery compared to the great saphenous vein. The bilateral internal thoracic artery had better long-term survival compared to great saphenous vein but may be associated with a higher risk of deep sternal wound infection and should be avoided in high-risk patients. The impact of skeletonization of the internal thoracic artery on graft patency and cardiovascular outcomes was unclear. Endoscopic vein harvest reduced the risk of leg wound complications and was associated with reduced long-term patency. The patency of the no-touch great saphenous vein was significantly better than that of conventional great saphenous vein. A significantly higher risk of complications at the harvesting site and no clear evidence of better long-term clinical outcomes were found in the no-touch great saphenous vein compared to the conventional. There was limited data on the use of right gastroepiploic artery and skeletonized harvesting, which should be used to bypass target vessels in patients with low competitive flow.

A Comparative Analysis of the Minimally Invasive Approach against the Traditional Open Harvesting Technique for Obtaining Iliac Bone Grafts in Secondary Alveolar Bone Grafting Procedures for Patients with Cleft Palate

Abstract: Secondary alveolar bone grafting (SABG) is an important surgery that people with cleft palate must have in order to have good dental rehabilitation. The goal of SABG is to create a stable alveolar ridge. The choice of graft picking method has a big effect on how well the surgery invasive harvesting methods used in iliac bone graft (SABG) procedures. The main points of the study are how happy the patients are, how these works and how well the patients do in the long run. This review study looks at the pros and cons of both traditional open harvesting and minimally methods have improved, and the results and problems that have happened.

Multiple Mini Incision Technique for Sural Nerve Harvest: When to Add a Fibular Incision Based on a New Surgical Classification

Sural nerve is the most common nerve used as a source for nerve grafting. Open harvest with longitudinal incisions produces unsightly scars, and this have led to development of less invasive techniques using endoscopes, nerve stripper, and mini-incisions. Several anatomical classifications have also been proposed due to the variations in the anatomy of the sural nerve. A simple and practical surgicoanatomical classification of the sural nerve based on which we have refined our minimal access technique, the multiple mini-incision technique for sural nerve harvest is proposed. In this technique, the incisions required for harvest of the sural nerve are standardized and predictable. A fibular incision is required when the sural nerve has major contribution from the common peroneal nerve. We have found this a simpler and reliable technique of harvest of sural nerve in nerve reconstructive surgery.

Clinical Pathology Reference Intervals for Juvenile Green (Chelonia mydas) and Hawksbill (Eretmochelys imbricata) Sea Turtles Captured in St. Kitts, 2004–2017

Historically, juvenile and subadult green (Chelonia mydas) and hawksbill (Eretmochelys imbricata) sea turtles have been observed in the waters surrounding St. Kitts, West Indies yearround; however, no formal population or health assessment for these species and cohorts in St. Kitts has been previously conducted. During the study period (2004–2017), 211 juvenile sea turtles (158 hawksbills, 53 greens) were captured at sixteen different capture sites in St. Kitts. Once on shore and restrained, morphometric measurements and mass were collected, untagged animals were tagged, and a health assessment was performed. Blood samples were collected and used to establish reference intervals for hematological and biochemical parameters. These reported reference intervals make it possible to incorporate monitoring programs for infectious diseases and to identify any trends in population and health status. The morphometrics, mass, and number of animals captured enable sound decision making as it relates to conservation policy development and implementation which is especially important in countries such as St. Kitts and Nevis where an open harvest for sea turtles still exists.

Demographic, spatial, and ecological aspects of Peltogyne mexicana - a threatened species – Under different extraction conditions in southern México

Peltogyne mexicana Martínez is a commercially attractive purple-hued hardwood tree of demographic, environmental and biogeographic rarity in southern Mexico. Despite P. mexicana’s status as a threatened species in Mexico, its populations are rarely managed and subject to open harvesting. Due to the limited number of P. mexicana studies that account for the influence of local tree extraction, we analyzed population-level parameters and community-level associations in two sites - one site called Tepehuaje with active P. mexicana extraction and another called Acahuizotla without extraction due to an ongoing P. mexicana moratorium. Using three 500 m2 plots per site, we characterized P. mexicana population size structure, abundance, spatial distribution, composition, and diversity of associated flora. In both sites, P. mexicana populations exhibited a type one size structure dominated by seedlings. Tepehuaje had 52% fewer saplings and juveniles and three times fewer adults when compared to the site without extraction. P. mexicana juvenile survival in Tepehuaje, a site with warmer climate and lower canopy cover, occurred mainly under trees with heavy foliage (including conspecifics). In Acahuizotla, a site with cooler climate and greater canopy cover, sapling and juvenile abundance was higher in open spaces and under small trees like Cascabela ovata. Although species richness was greater in Acahuizotla, species diversity was higher in Tepehuaje likely due to regularly opened gaps from artisanal logging that limited dominance of certain species. An importance value index (IVI) analysis based on dominance, abundance, and foliar coverage of associated P. mexicana plant communities revealed differences between Acahuizotla (Tetrapterys spp., followed by Plumeria rubra L) and Tepehuaje (Citharexylum affine D. Don, and Bauhinia ungulata L). All species associated with P. mexicana were found to be characteristic of tropical subdeciduous forests. Studying P. mexicana demography and ecology expands the limited knowledge we have of a rare, yet biologically important, species, and sheds light on local practices that can improve persistence.

Robotic Rectus Abdominis Harvest for Pelvic Reconstruction after Abdominoperineal Resection.

The use of robotic surgical systems to perform abdominoperineal resection (APR) has recently become more prevalent. This minimally invasive approach produces fewer scars and potentially less morbidity for the patient. The rectus abdominis muscle is often used for reconstruction after APR if primary closure is not feasible or the surgical site is at high risk of wound complications. Since the traditional open harvest of this flap creates large incisions that negate the advantages of minimally invasive APR, there has been growing interest in harvesting the rectus abdominis in a similarly robotic fashion. This article reviews the technique, benefits, and limitations of this robotic technique. Compared to the traditional open harvest, robotic harvest of the rectus abdominis leaves smaller scars, provides technical benefits for the surgeon, and offers possible morbidity benefits for the patient. These advantages should be weighed against the added expense and learning curve inherent to robotic surgery.

Down with the Bean Bag: A Multi-institutional Experience with Total Latissimus Muscle Free Flap Harvest in the Supine Position.

The latissimus muscle continues to be a head to toe workhorse in free tissue transfer for coverage of large defects. Traditional full muscle harvest is performed in the lateral decubitus position which is frequently suboptimal or requires position change based on the recipient site and laterality. We present a multi-institutional case series of full muscle flap harvest from the supine position for a range of defects in 32 patients. The relevant operative setup and technique are described. In our experience, supine harvest has become the preferred open harvest technique compared to lateral positioning for both optimal exposure of the pedicle and reduction in operating time.

Effects of the harvesting technique and external stenting on progression of vein graft disease 2 years after coronary artery bypass.

In a post hoc analysis of the VEST III trial, we investigated the effect of the harvesting technique on saphenous vein graft (SVG) patency and disease progression after coronary artery bypass grafting. Angiographic outcomes were assessed in 183 patients undergoing open (126 patients, 252 SVG) or endoscopic harvesting (57 patients, 114 SVG). Overall SVG patency was assessed by computed tomography angiography at 6 months and by coronary angiography at 2 years. Fitzgibbon patency (FP I, II and III) and intimal hyperplasia (IH) in a patient subset were assessed by coronary angiography and intravascular ultrasound, respectively, at 2 years. Baseline characteristics were similar between patients who underwent open and those who underwent endoscopic harvesting. Open compared with endoscopic harvesting was associated with higher overall SVG patency rates at 6 months (92.9% vs 80.4%, P = 0.04) and 2 years (90.8% vs 73.9%, P = 0.01), improved FP I, II and III rates (65.2% vs 49.2%; 25.3% vs 45.9%, and 9.5% vs 4.9%, respectively; odds ratio 2.81, P = 0.09) and reduced IH area (-31.8%; P = 0.04) and thickness (-28.9%; P = 0.04). External stenting was associated with improved FP I, II and III rates (odds ratio 2.84, P = 0.01), reduced IH area (-19.5%; P < 0.001) and thickness (-25.0%; P < 0.001) in the open-harvest group and reduced IH area (-12.7%; P = 0.01) and thickness (-9.5%; P = 0.21) in the endoscopic-harvest group. A post-hoc analysis of the VEST III trial showed that open harvesting is associated with improved overall SVG patency and reduced IH. External stenting reduces SVG disease progression, particularly with open harvesting.

Saphenous vein graft longevity: open or endoscopic, with VEST or without?

We have read the article by Sandner et al. with great interest. The authors have undertaken a post hoc analysis of the VEST III Trial to examine the impact of open versus endoscopic harvesting techniques on saphenous vein graft patency and degree of intimal hyperplasia. As already acknowledged by the authors, these results should be viewed as hypothesis generating because of the inherent limitations of a post hoc, unplanned analysis. The key findings of the paper point towards a better saphenous vein graft patency and reduced intimal hyperplasia of open harvest technique compared to endoscopic harvest. The reduced graft patency associated with endoscopic harvest has already been suggested in the literature [1], and this could be related to several factors. Endoscopic vein harvest is a relatively newly established technique where graft patency is influenced by the operator experience, something that has not been accounted for in the VEST III trial. Other factors intrinsic to the endoscopic harvest technique that result in poorer patency include the thermal diathermy injury of the conduit or more traumatic handling/stretch of the conduit that translates into histological evidence of trauma [2]. A strength of the paper is the within-patient randomized that mitigated the potential effect of variability in saphenous vein preparation on graft patency. For example, an open no-touch technique or the distending pressure used on the vein for leaks check are known determinants of angiographic graft patency [3] and graft wall remodelling [4].

Robotic Harvest of the Deep Inferior Epigastric Perforator Flap for Breast Reconstruction: A Case Series.

Robotic surgery is emerging as a viable tool in reconstructive surgery. Harvesting of the deep inferior epigastric perforator flap is typically performed through an anterior approach, which involves a long fascial incision. A robotic approach allows the deep inferior epigastric pedicle to be harvested from the posterior surface. This approach reduces the length of the fascial incision and should decrease the abdominal morbidity associated with large fascial dissections. A case series study of 21 patients who underwent a robotic deep inferior epigastric perforator or during a 12-month period for breast reconstruction was performed. Patient demographics, surgical characteristics, and complications were assessed. Mean patient age was 54.6 ± 7.6 years, and mean body mass index was 30.4 ± 3.9 kg/m2. Mean fascial incision and pedicle length were 3.6 ± 1.6 cm and 13.3 ± 1 cm, respectively. None of the patients required conversion to open harvest. Mean length of hospital stay was 3.8 ± 0.9 days. Surgical site occurrences were identified in five patients (31.3 percent). One patient had delayed wound healing at the donor site. None of the patients developed hernia or bulge. The mean benefit (B = C - A), defined as length of fascial incision spared and measured as the difference between pedicle length and intramuscular course, was 9.83 ± 2.28 cm. The precision of computed tomography angiography in identifying the intraoperative fascial incision was 86 percent. The robotic deep inferior epigastric perforator flap is a safe and reliable technique that decreases the length of fascial incision and short-term complications associated with the open approach. Therapeutic, IV.

A review of the best method of leg wound closure following open harvesting of the long saphenous vein for coronary artery bypass grafting

Uncertainty exists around the optimal method of leg wound closure following open long saphenous vein harvesting in adults undergoing coronary artery bypass graft surgery (CABG). Such is evident from the variety observed in the closure approach utilised. Consequently, a best evidence topic in cardiac surgery was written according to a structured protocol. The question addressed was ‘following open long saphenous vein harvesting in adults undergoing CABG, is single-layer leg wound closure superior to multiple-layer closure in terms of post-operative complications encountered? ‘. Altogether 382 papers on Ovid Embase and Ovid Medline, 301 papers on PubMed and 11 papers on the Cochrane database were found using the reported search. From the screened articles, 6 represented the best evidence to answer the clinical question. The authors, journal, date and country of publication, patient group studied, study type, relevant outcomes and results of these papers are tabulated. We conclude that the best method of leg closure following open saphenous vein harvesting for CABG is single-layer cutaneous closure. The use of a suction drain to eliminate the dead space should be considered on a case-to-case basis by the lead operating surgeon with the patient's characteristics and their own expertise in mind.

Endoscopic Versus Open Radial Artery Harvesting Used in Coronary Artery Bypass Grafting, Our Experience at Queen Alia Heart Institute

Coronary artery stenosis bypass by using radial artery is good techniques which have longer outcomes. In coronary artery bypass grafting (CABG) the radial artery has several advantages. The radial artery has a thick muscular wall which is more susceptible to contraction from the competitive flow. As compared to the open harvesting technique endoscopic harvest of the radial artery has long lasting cosmetic results it also reduces the post-operative complications. The purpose of the study is to compare the two harvesting techniques and compare the short term and long term results related to intra-operative and post-operative outcomes Methods: This is retrospective study (In Queen Alia Heart Institute, Amman ,Jordan) to compare endoscopic radial artery technique versus open technique by reviewing patients files through a period between June 2013 and June 2018. Total 50 patients of CABG surgery was selected they were divided into two groups. Group A includes endoscopic radial harvest (n= 10) and Group B includes open harvest (n=40). Data was collected on predesigned Performa. Data were entered and analyze through IBM SPSS 22.0 Results: There was insignificant dissimilarity between the pre-operative outcomes between groups. The Post-operative outcomes were almost same in both groups except hand numbness (P-value&lt;0.005). The comparison of intraoperative outcomes like harvest time between both groups indicate that the mean harvest time in group A was shorter than group B (39.20 + 3.73 Vs 51.90 + 2.09, P-value=0.000). The operative time in group A was higher than the group B (306.0 + 11.6 Vs 278 + 4.25 p-value=0.00). The hospital stays in both groups were insignificantly different (p = 0.09) Conclusions: Endoscopic radial artery harvest is best suited technique for CABG surgery as it significantly decreases the harvest time as well as hospital stay. It is also proven that it is safer, less painful and better wound appearance technique with exceptional outcomes based on positive surgical experience.

Technical Aspects of Radial Artery Grafting for Coronary Surgery

The radial artery (RA) has seen a recent resurgence in coronary artery bypass grafting (CABG) surgery. Recent randomized evidence has shown higher long-term patency rates and better clinical outcomes with the RA when compared to other conduits such as the right internal thoracic artery and saphenous vein grafts. In fact, the RA is now class I indication as the second conduit in CABG. Therefore, it is important that the coronary surgeon is familiar with the RA and its use in CABG. In this report we describe our operative technique for RA harvesting and use in CABG. As with any surgical procedure, patient selection is key. We describe our approach to screening including duplex ultrasonography and plethysmography, endoscopic and open harvesting techniques, preservation and grafting strategies, target vessel selection, and anastomotic techniques. The radial artery (RA) has seen a recent resurgence in coronary artery bypass grafting (CABG) surgery. Recent randomized evidence has shown higher long-term patency rates and better clinical outcomes with the RA when compared to other conduits such as the right internal thoracic artery and saphenous vein grafts. In fact, the RA is now class I indication as the second conduit in CABG. Therefore, it is important that the coronary surgeon is familiar with the RA and its use in CABG. In this report we describe our operative technique for RA harvesting and use in CABG. As with any surgical procedure, patient selection is key. We describe our approach to screening including duplex ultrasonography and plethysmography, endoscopic and open harvesting techniques, preservation and grafting strategies, target vessel selection, and anastomotic techniques. Commentary: Techniques Within Arm's ReachOperative Techniques in Thoracic and Cardiovascular SurgeryVol. 26Issue 4PreviewMultiple arterial revascularization (MAR) in coronary artery bypass grafting (CABG) has seen increased use1 for its mortality and morbidity benefits,2 and currently receives a IIa recommendation by the European Society of Cardiology/European Association for Cardio-Thoracic Surgery (ESC/EACTS). The radial artery (RA) has a ESC/EACTS Class I recommendation based on promising long-term clinical and patency outcomes.3 Dr. Mario Gaudino has contributed significantly to the current understanding of RA grafting and its’ acceptance as an excellent conduit choice. Full-Text PDF

Laparoscopy allows the harvest of the DIEP flap with shorter fascial incisions as compared to endoscopic harvest: A single surgeon retrospective cohort study

We present a comparative series to utilize minimally invasive endoscopic, total extraperitoneal laparoscopic (TEP-lap), and transabdominal preperitoneal robotic perforator (TAP-RAP) harvest of the deep inferior epigastric (DIE) vessels for autologous breast reconstruction (ABR) to mitigate donor site morbidity. We hypothesized that TEP-lap and TAP-RAP harvests of abdominal-based free flaps are safe techniques associated with decreased fascial incision when compared with the endoscopic harvest. We designed a retrospective cohort series of subjects with newly diagnosed breast cancer who presented for ABR using endoscopic (control), laparoscopic, or robotic assistance between September 2017 and April 2019. The primary outcome variables were flap success (i.e., absence of perioperative flap loss), fascial incision length, and intraoperative complications. Secondary variables included operating time, costs, and postoperative complications within 90 days (arterial thrombosis, venous congestion, bulge/hernia, and operative revision). Exclusion criteria included < 90 days follow-up. In total 94, 38, and 3 subjects underwent endoscopic, TEP-lap, and TAP-RAP flap harvests. Mean lengths of fascial incisions for the endoscopic and laparoscopic cohorts were 4.5 ± 0.5 cm and 2.0 ± 0.6 cm (p<0.0001), while incision length depended on the concurrent procedure in the robotic cohort. No subjects required conversion to an open harvest. There were no bleeding complications, intra-abdominal injuries, flap losses, or abdominal bulges/hernias noted in the TEP-lap and TAP-RAP cohorts. Minimally invasive DIEP flap harvest may decrease fascial injury when compared with conventional open harvest. There are significant trade-offs among harvest methods. TEP-lap harvest may better balance the trade-off related to abdominal wall morbidity.

Is endoscopic radial artery harvesting open for business?

With the resurgence of the radial artery in coronary artery bypass grafting, the debate on the optimal harvesting technique continues. Here, we comment on a randomized series in which the authors conclude that endoscopic harvesting techniques offer the benefit of improved cosmetic outcomes and decreased neurological complications with comparable graft-related outcomes when compared with open harvesting. We conclude that although this study is well designed and conducted, there are several areas of concern including surgical technique and statistical power.

Long-term, Harvest-based Monitoring of Ringed Seal Body Condition and Reproduction in Canada’s Western Arctic: An Update through 2019 + Supplementary Appendix 1 (See Article Tools)

The circumpolar Arctic ringed seal (Pusa hispida) occupies its fast-ice breeding habitat for four to five months during winter and the pack ice or open water of adjacent areas for the rest of the year. From 1971 – 78 and 1992 – 2019, we sampled approximately 100 ringed seals annually from western Prince Albert Sound (WPAS), the prime ringed seal fast-ice breeding habitat in Canada’s Western Arctic, adjacent to primary overwinter foraging habitat in eastern Amundsen Gulf (EAG). As our metric of body condition, we measured ventral blubber depth corrected for body size. As our metrics of reproduction, we measured the annual ovulation rate of multiparous females and percent pups in the open-water harvest. We examined these biological parameters in relation to the winter Arctic Oscillation Index (winAOI) and the timing of sea ice clearance in EAG in spring. There were no significant effects of age or sample month (June or July) on adult blubber depth, but significant sex and year effects and, in females, ovulation status effects. Across the series, as we have observed previously through 2011, there was a sustained temporal declining trend in blubber depth in adults of both sexes. There was no temporal trend in residual blubber depth, no correlation between blubber depth and sea ice clearance date in EAG, and a quasi-cyclic pattern in blubber depth that tracked some of the phases of the winAOI. Annual ovulation rates were mainly in the 80% – 100% range and correlated with percent pups in the open harvest in the same year. Three (1974, 2005, 2012) of the 36 y experienced reproductive failures, when over 50% of the multiparous females failed to ovulate. In each case, ovulation rates returned to normal within 1 – 3 y. Low annual ovulation rates were correlated with late sea ice clearance in EAG in spring, with two widespread ovulation failure events taking place in years when spring sea ice clearance was delayed by five to six weeks. The most recent ovulation failure (2012) differed in that it came in an average ice year but at the end of a six-year sequence of negative residual mean blubber depths. Earlier spring sea ice clearance in WPAS, based on the observed rate of 3.8 d per decade, would on average not result in the physical loss of sea ice for pupping in this core habitat before 2140. The mechanisms involved in the sustained declining temporal trend in body condition, linkage with some phases of the winAOI, and the temporary but episodic failures of ovulation are complex and not fully explained by either the timing of sea ice clearance or the winAOI. Until the complex mix of factors, pressures and responses are understood, our ability to predict the impacts of a changing climate on ringed seals will remain limited.

Examining the Safety and Efficacy of Supplemental Regional Anesthesia After Iliac Crest Harvest During Cleft Alveolar Bone Grafting

Background: The optimal prevention and treatment of pain associated of iliac crest bone graft donor sites for the treatment of cleft alveolus defects has not been well characterized. The aim of this study is to assess the efficacy of minimal access bone graft techniques with or without regional anesthesia in iliac crest bone harvest and compare to outcomes to traditional open harvest techniques. Methods: A retrospective review of 46 patients undergoing iliac crest bone harvest using traditional open iliac crest bone graft (ICBG) alone (Group 1, n = 20), minimal access ICBG (Group 2, n = 20), or minimal access ICBG with paravertebral anesthetic block (Group 3, n = 5) was performed. Post operative pain scores, narcotic consumption, and hospital stay were analyzed. Results: The average time to first narcotic was 247 minutes in Group 1, 193 in Group 2, and 1162 minutes in Group 3 ( P &lt; .0002). Total narcotic use was 0.117 mg/kg in Group 1, 0.131 mg/kg in Group 2, and 0.072 mg/kg in Group 3. The average pain score (VAS) was 2.96 in Group 1, 1.83 in Group 2, and 1.08 in Group 3 ( P &lt; .01). The average length of stay was 1.45 for Group 1, 1.36 for Group 2, and 1.0 for Group 3. Bone graft extrusion occurred in 6 patients (27.3%) in Group 1 and none in Group 2 or 3. There were no wound infections, bleeding requiring reoperation, or mortalities. Conclusion: The addition of regional anesthesia to minimal access alveolar bone graft harvest significantly reduces time to first narcotic use. Although not significant, a strong trend was found with regional anesthesia to lower the pain score (VAS) and total narcotic use. Regional anesthesia did not significantly reduce the length of hospital stay compared to either group. Minimal access techniques with supplemental regional anesthesia significantly lowered the pain score and time to first narcotic and trended to decreased length of hospitalization and total narcotic use compared to traditional open techniques.

The clinical application of microincision vein harvesting of the great saphenous vein in coronary artery bypass grafting

BackgroundThe present study aimed to summarize the clinical application of microincision vein harvesting (MVH) of the great saphenous vein in coronary artery bypass grafting (CABG).MethodsFrom July 2014 to October 2017, 160 patients underwent coronary artery bypass grafting. Among them, 80 patients received MVH of the great saphenous vein, and 80 received open venous harvesting (OVH). The results of the sampling operation, complications during hospitalization, and the long-term patency of the great saphenous vein were compared between the two groups.ResultsAll the patients in both groups received successful operations. The difference in the length of the veins obtained and the injury of the veins was not statistically significant (P > 0.05). The difference in the long-term patency rate of the graft vessels between the two groups was not statistically significant. The in-hospital mortality rate was the same in both groups. The MVH group had noticeable advantages over the OVH group in terms of the vein collection times, the incision length, and the complications experienced when performing the leg incisions (P < 0.01). The time relating to the patients’ observed early out-of-bed activity was significantly longer in the MVH group. Furthermore, the patients’ hospitalization length was significantly shorter in the MVH group compared to the OVH group (P < 0.05). The MVH group had significant advantages in pain score and patient satisfaction, and this difference was also statistically significant (P < 0.05).ConclusionsThe MVH procedure met the requirements of CABG in vein grafting. When compared with OVH, MVH can significantly reduce leg incision complications and improve patients’ overall satisfaction with their hospital experience.

V02-12 ROBOTIC FASCIAL SPARING RECTUS ABDOMINIS HARVEST

INTRODUCTION AND OBJECTIVE:The rectus abdominis muscle is a useful flap for multiple surgical repairs including complex posterior urethral fistula repair. Traditional open harvest with anterior she...