Dr Parikh attends to a CABG patient

Bypass surgery with endoscopic approach to saphenous vein harvesting is a noteworthy breakthrough in the modern medical era as this minimally invasive surgery provides rapid recovery to Coronary Artery Bypass Graft (CABG) patients, says Dr Suhas J. Parikh, Hon. Consultant Cardiovascular and Thoracic surgeon at KEM Hospital and Sir Hurkishandas N Hospital, Mumbai.

According to Dr. Parikh, who has performed the successful bypass surgery with the use of this technique at Sir H. N. Hospital in Mumbai for the first time, very few centers in the world are using the technique. However, Dr Parikh's surgery in Mumbai has put India as well on the map.

Dr. Parikh, who was trained for Minimally Invasive Bypass Surgery and Robotic surgery at Germany, France, USA and Australia stresses that though India has highly skilled manpower but the expensive equipments and also the Govt. regulations, which do not allow the modern medicine, these kind of technologies are not coming to the access of common man.

In the normal course of bypass surgery, Coronary artery that is blocked is bypassed using Saphenous vein form the leg, Radial artery from the arm, or IMA from the chest. Length of this is equal to the coronary artery that is to be bypassed. Hence long incisions are required on the arm and Leg about 15-40cms. With this earlier largely invasive surgery, post-operatively patient experiences pain and discomfort during walking. Moreover infection can take place making patient more miserable, Dr Parikh said.

However, this new technique requires only 2.5cm incision for the insertion of endoscope and this technique reduces surgical invasiveness. Only 1-3 small (2 cm. long) incisions are required to harvest the vein depending upon the length of the vein required, he adds. Commenting on the endoscopic approach, Dr Parikh said that it requires expensive equipment and like any other endoscopic procedure it needs Equipment required for Endoscopic surgery. i.e. Endoscope, camera, TV monitor.

Talking about endoscopic approach, he said that a small incision is made on the leg and the vein is identified and dissected. The Endoscope is now inserted inside a specially designed cannula. This cannula is inserted into the incision and the cannula is advanced over the vein. As the cannula is advanced, a tunnel is created in the leg. The vein visualized in the tunnel is seen on the TV monitor. Then the doctor can dissect the required length which can be 15-40cm in length. During this CO2 insufflation is also done. Using special instruments the vein is dissected, looking at the TV monitor, all its branches are clipped and cut. Thus, saphenous vein harvested by this technique requires only 2-3 small incisions.

Endoscopic dissecting technique is now being applied for the dissection of other arteries. (1) harvesting of Radial arteries from the forearm and (2) Internal mammary artery while doing Minimally invasive surgery to ensure full length dissection of IMA.

In a developing nation like India, the advancement of medicine has reached heights, and bypass surgery is a commonly performed procedure. Therefore, further advancement in this field by the use of Endoscopy, that results in the rapid recovery of the patient, is truly welcomed, especially for the diabetic patients who undergoes bypass surgery. This technology is really a boon to diabetic patient, it is less invasive and the possible chance of getting infection on the wound and the natural lengthy healing period can be avoided.

The major advantages of this technique are the reduced invasiveness of the harvesting procedure, less pain, less scarring, less wound infection and a better wound healing.

This may reduce the subsequent stay in the hospital, Dr Parikh says.