A comprehensive review on learning curve associated problems in endoscopic vein harvesting and the requirement for a standardised training programme

Endoscopic vein harvesting is becoming one of the most favourable vein harvesting techniques in multiple bypass
coronary surgery, due to its short term post-operative benefits with high patient satisfaction. However, long-term
graft patency has been both supported and questioned in the literature. Graft failure can be affected by harvesting
methods and operator’s experience. Endoscopic vein harvesting is associated with a learning curve period, during
which the incidence of vein trauma is high due to unfamiliarity with the surgical technique. There is a paucity of
structured learning tools for novice practitioners, meaning that training differs significantly between hospital centres.
Inconsistent training methods can lead to poor surgical technique, which can have a significant impact on vein quality
and stress level of the practitioner. In turn, this can lead to increased postoperative complications and longer surgical
duration. The main aim of this literature review is to understand the impact of the learning curve on the vein conduit
and whether there is a requirement for a standardised training programme for the novice practitioners.
Keywords: Coronary artery bypass, Saphenous vein, Endoscopic vein harvesting, Learning curve