JTCS Tips for Better Browsing
HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS
QUICK SEARCH:   [advanced]


     

This Article
Right arrow Alert me when this article is cited
Right arrow Alert me if a correction is posted
Services
Right arrow Email this article to a friend
Right arrow Similar articles in this journal
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Add to Personal Folders
Right arrow Download to citation manager
Right arrow Permission Requests
Citing Articles
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by Sawamura, Y.
Right arrow Articles by Ito, T.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Sawamura, Y.
Right arrow Articles by Ito, T.
Related Collections
Right arrowRelated Article

J Thorac Cardiovasc Surg 2000;120:617
© 2000 The American Association for Thoracic Surgery

Letters to the Editor

A pitfall of reusing disposable apparatus for endoscopic surgery

Yoshihiro Sawamura, MD, Kei Takase, MD, Haruo Saito, MD, Sekinori Kikuchi, MD, Takashi Ito, MD

Departments of Cardiovascular Surgery and Radiology
Ishinomaki Red Cross Hospital
Yoshino-cho
1-7-10, Ishinomaki City Miyagi 986-8522, Japan

To the Editor:

Endoscopic vein harvest for coronary artery bypass grafting is a relatively new procedure reported by Davis and associates.Go 1 This is a safe, effective, and less-invasive procedure for the patients. Their endoscopic vein harvest technique is as follows: A transverse 2- to 3-cm incision is made at the medial aspect of thigh 10 cm above the knee. The greater saphenous vein is identified, and an area over the vein is dissected to create a space that would allow the entry of a subcutaneous dissector (Ethicon EVH kit, Ethicon Endo-Surgery, Inc, Cincinnati, Ohio). A 300-mm 30° endoscope is then inserted through a port in the dissector, and the camera view is properly oriented. The subcutaneous dissector is inserted into the space. By indirect vision via the video monitor, blunt dissection is initiated along the anterior surface of the vein. This dissection process is continued out to the saphenous-femoral junction. The vein is then removed from the leg and prepared for grafting.

We report here an unexpected event that occurred during endoscopic vein harvesting. We used the same Ethicon EVH kit as Davis and associates. Although this device is disposable, we usually reused it several times if it was not broken or if it was not used for a patient with a viral infection, such as human immunodeficiency virus, hepatitis B or C virus, or adult T-cell leukemia virus. When the saphenous vein was dissected to the midportion of the leg, we removed the large dissector and changed it to the small one. At that time, we noted that the tip of the large dissector had been crushed (Fig 1, A ). We continued harvesting using a new EVH kit and, fortunately, we could see a small piece of broken tip with the video monitor. We were able to remove the small piece from the wound safely (Fig 1, B ).



View larger version (136K):
[in this window]
[in a new window]
  		Fig. 1. Color photographs of the broken tip of the Ethicon EVH kit. A, Three pieces of the broken tip. Black arrow shows the smallest piece left in the wound. B, The smallest piece of the broken tip of the EVH dissector in a steel dish 8 cm in diameter.

 
Because of economics, surgeons tend to reuse disposable equipment. However, in the field of endoscopic surgery, surgeons have to operate through a small wound with limited exposure. We cannot deny the possibility of accidentally leaving a foreign body in the patient's wound. From our experience, the likelihood that reused equipment may be damaged or crushed is relatively high. Therefore, we conclude that reuse of the disposable EVH kit must be carefully considered, especially in endoscopic surgery.

References

  1. Davis Z, Jacobs HK, Zhang M, Thomas C, Castellanos Y. Endoscopic vein harvest for coronary artery bypass grafting: technique and outcomes. J Thorac Cardiovasc Surg 1998;116:228-35. [Abstract/Free Full Text]

Related Article

Editorial comment
Andrew S. Wechsler
J. Thorac. Cardiovasc. Surg. 2000 120: 617. [Extract] [Full Text]




This Article
Right arrow Alert me when this article is cited
Right arrow Alert me if a correction is posted
Services
Right arrow Email this article to a friend
Right arrow Similar articles in this journal
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Add to Personal Folders
Right arrow Download to citation manager
Right arrow Permission Requests
Citing Articles
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by Sawamura, Y.
Right arrow Articles by Ito, T.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Sawamura, Y.
Right arrow Articles by Ito, T.
Related Collections
Right arrowRelated Article

HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS
ANN THORAC SURG ASIAN CARDIOVASC THORAC ANN EUR J CARDIOTHORAC SURG
J THORAC CARDIOVASC SURG ICVTS ALL CTSNet JOURNALS