Laparoscopic vein harvest gains favor

Teams save on comps from CABG vein harvesting

For more than a year now, the vein harvesting team at Jewish Hospital in Cincinnati has been doing its work laparoscopically, and the technique has been getting good, cost-effective results. The video procedure eliminates the long leg incision — sometimes 40 cm or more — required to harvest the saphenous vein for use in coronary artery bypass surgery (CABG) and reduces postoperative pain and recovery time. Leg complications, including blood clots, fluid build-up, and drainage, are less for patients who undergo the endoscopic procedure, as are the number of follow-up office visits required for leg care.

"Patients used to complain bitterly about leg pain after vein harvesting," says Michael Bowen, PA, RN, administrative director of the department of surgery at Jewish Hospital. "Since we began using the scope, patients recover well and don’t hurt as much."

"Much of the pain associated with CABG is actually caused by the leg incision, not the sternotomy," explains Lynn B. McGrath, MD, chief of cardiothoracic surgery at Deborah Heart and Lung Center located in Browns Mills, NJ. Deborah also offers patients videoscopic saphenous vein harvesting.

In the videoscopic procedure, the surgeon makes two or three two-inch incisions in the leg for insertion of a small, narrow scope. The veins are drawn through the openings.

"The cost of the laparoscopic equipment depends on the manufacturer, but disposable kits we use run anywhere from $350 to $550," says Gary Sheldon, perioperative specialist in the surgery department at Jewish Hospital. "No additional operating room time is involved, so that cost stays the same." Vein harvest times are somewhat longer for the endoscopic procedure, but closure times are less because of the small incision, resulting in no time difference for the total procedure.

The scope alone represents a capital outlay of about $3,500, but the device, light sources, and other related equipment may already be at your hospital, as they are at Sheldon’s, because they are used in other areas of the facility for arthroscopies and gynecologic procedures.

"It’s difficult to quantify cost," says Bowen, "but you have to take into consideration the fact that when you do minimally invasive surgery on the leg, you avoid infection, so that potential extended hospitalization is avoided."

Laparoscopic harvesting is reimbursable, just like traditional methods. "The disposable trocars and other equipment are more expensive than traditional tools," says Bowen, "but those costs are passed on and reimbursed."

When looking at the cost-effectiveness of this procedure vs. that of the traditional harvest, you have to first consider the cost of the supplies. One company that manufactures a basic disposable kit is Guidant Corporation of Menlo Park, CA. Its VasoView kit costs $550-650 and includes:

  • balloon dissection cannula;
  • Uniport cannula;
  • 12-mm blunt-tip trocar;
  • bipolar scissors;
  • bisector;
  • syringe.
When using the VasoView system, your capital outlay for equipment includes about $3,200 for a 5 mm extended length endoscope, which is specific to the system, and a video cart that holds the camera head, monitor, and light source.

On the plus side is a reduction in supply use. The traditional vein harvesting procedure requires about six packages of sutures at $22 per package. The endoscopic procedure calls for just one pack, saving $110. Four packs of lap sponges are required for the traditional procedure at $15 a pack. Add to those expenses the cost of clips, dressings, and other supplies, and Nina Fernandes of Guidant estimates overall savings are $300-350 per procedure. "Over a year, you’re probably going to come out with a break-even proposition."

Endoscopic harvesting has a fairly long learning curve — it can take 25 to 35 procedures for a surgeon to get comfortable with the procedure, according to Fernandes.