A Prospective Randomized Study of Endoscopic versus Conventional Harvesting of the Radial Artery

Objective The aims of the study were to determine whether endoscopic harvesting of the radial artery (RA) reduces morbidity due to pain, infection, and disability with improvement in satisfaction and cosmesis compared to the conventional technique and (2) to compare the 6-month angiographic patency of the RA harvested conventionally and endoscopically. Methods In a prospective randomized study, 119 patients undergoing coronary artery bypass grafting using the RA were randomized to have RA harvested either conventionally (n = 59) or endoscopically (n = 60). Results Radial artery harvest time (open wound time) was significantly reduced in the endoscopic group (36.5 ± 9.4 vs 57.7 ± 9.4 minutes, P < 0.001). Only one patient developed wound infection (1.6%) in the endoscopic group compared with six patients (10.2%), P = 0.061, in the conventional group. Although this was not statistically significant, clinically this was relevant in terms of reduction in postoperative morbidity. Postoperative pain in the arm incision was significantly lower in the endoscopic group at postoperative day 2 ( P < 0.001) and at discharge ( P < 0.001) and similar to the conventional open group at 6 weeks’ follow-up ( P = 0.103). Overall patient satisfaction and cosmesis were significantly better in the endoscopic group at postoperative day 2 ( P < 0.001), at discharge ( P < 0.001), and at 6 weeks’ follow-up ( P < 0.001). There was no difference in the arm disability postoperatively ( P = 0.505) between the two groups. Six-month angiographic assessment of 23 patients (12 endoscopic and 11 open) revealed no difference in the patency rate (10/12 in endoscopic and 9/11 in open group). Conclusions Endoscopic RA harvesting reduced the incidence of postoperative wound infection and wound pain and improved patient satisfaction and cosmesis compared with conventional harvesting technique. There was no difference in the 6-month angiographic patency of the RA harvested conventionally and endoscopically.

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Comparison of electrocautery and LigaSure™ vessel sealing system in radial artery harvesting as coronary artery bypass surgery conduit: A prospective, randomized study

Cardiovascular Surgery and Interventions ◽

10.5606/e-cvsi.2021.1128 ◽

2021 ◽

Vol 8 (2) ◽

pp. 98-102

Author(s):

Murat Ökten

Keyword(s):

Coronary Artery ◽

Coronary Artery Bypass ◽

Radial Artery ◽

Coronary Artery Bypass Surgery ◽

Bypass Surgery ◽

Artery Bypass ◽

Randomized Study ◽

Prospective Randomized Study ◽

Vessel Sealing System ◽

Vessel Sealing

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Impact of procedural multimedia instructions for pH BRAVO testing on patient comprehension: a prospective randomized study

Diseases of the Esophagus ◽

10.1093/dote/doz068 ◽

2019 ◽

Cited By ~ 2

Author(s):

M D Moore ◽

K D Gray ◽

S Panjwani ◽

B Finnerty ◽

T Ciecerega ◽

...

Keyword(s):

Patient Satisfaction ◽

Randomized Study ◽

Data Entry ◽

Prospective Randomized Study ◽

Control Group ◽

Patient Comprehension ◽

Significant Difference ◽

Comprehension Score ◽

Video Group

SUMMARY The positive impact on patient comprehension and improved procedural outcomes when multimedia is utilized to convey instructions preprocedurally has been previously shown for gastrointestinal procedures such as colonoscopy. However, in gastroesophageal reflux testing (GERD), we continue to utilize verbal and written instructions to establish this diagnosis when we use BRAVO pH testing. This is arguably a more complex procedure involving stopping medications, placement of a device, and maintaining an accurate diary for the duration of the testing. We hypothesize that by utilizing multimedia to relay complex textual information, patients will have improved comprehension of periprocedural instructions thereby improving data entry and satisfaction of expectations during the procedure. Prospective randomized study of 120 patients undergoing endoscopic placement of the BRAVO pH monitoring capsule for evaluation of GERD receive either written preoperative instructions (control) or written plus video instructions (video group). A composite comprehension score was calculated using procedure-specific parameters of data entry over the 48-hour monitoring period. Patient satisfaction was evaluated on the basis of a five-point Likert scale. Extent of patient satisfaction was defined by the fulfillment of patient expectations. Exclusion criteria included patients who did not have access to the video or did not complete follow-up. Seventy-eight patients completed all follow-up evaluations. The video group (n = 44) had a significantly higher mean comprehension score when compared to the control group (n = 34) (9.6 ± 1.4 vs. 7.4 ± 2.0, P = 0.01). Overall satisfaction with instructions was significantly higher in the intervention group (91% vs. 47%, p 0.01). We detected no significant difference in comprehension or satisfaction scores in subgroup analyses of the video group comparing patients <65 and ≥65 years of age and by education level. Compared to standard written instructions, video instructions improved patient comprehension based on data evaluation, and satisfaction. Therefore, clinicians should consider incorporation of multimedia instructions to enhance patient periprocedural expectations and understanding of reflux pH testing using the BRAVO procedure.

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Endoscopic Plantar Fascia Release versus Cryosurgery for the Treatment of Chronic Plantar Fasciitis: A Prospective Randomized Study

Journal of the American Podiatric Medical Association ◽

10.7547/18-082 ◽

2019 ◽

Vol 110 (5) ◽

Author(s):

Bilgehan Çatal ◽

Ali Bilge ◽

Ragıp Gökhan Ulusoy

Keyword(s):

Patient Satisfaction ◽

Plantar Fasciitis ◽

Outcome Measurement ◽

Randomized Study ◽

Surgical Techniques ◽

Plantar Fascia ◽

Prospective Randomized Study ◽

American Orthopaedic ◽

Plantar Fascia Release

Background In a prospective randomized study, we compared two different surgical techniques used in plantar fasciitis surgery. Methods Forty-eight patients diagnosed as having plantar fasciitis and treated for at least 6 months with no response to conservative modalities were included in this study. The patients were randomly assigned to receive endoscopic plantar fascia release (EPFR) or cryosurgery (CS). Patients were evaluated using the American Orthopaedic Foot and Ankle Society Ankle-Hindfoot Scale (AOFAS-AHS) as a primary outcome measurement at baseline and 3 weeks and 3, 6, and 12 months after surgery. At the final follow-up visit, the Roles-Maudsley score was used to determine patient satisfaction. Results Five patients did not complete the 1-year follow-up examination (one in the EPFR group and four in the CS group). Thus, the study group included 43 patients. Although both groups showed significant improvement at the final evaluation, the patients in the EPFR group had significantly better AOFAS-AHS scores at 3 months. The success rate (Roles-Maudsley scores of excellent and good) in the EPFR group at 12 months was 87% and in the CS group was 65%. Conclusions Both EPFR and CS were associated with statistically significant improvements at 1-year follow-up. At 3-month follow-up, EPFR was associated with better results and a higher patient satisfaction rate compared with CS.

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Endoscopic Radial Artery Harvest Produces Equivalent and Excellent Midterm Patency Compared with Open Harvest

Innovations Technology and Techniques in Cardiothoracic and Vascular Surgery ◽

10.1097/imi.0b013e3181ee93f0 ◽

2010 ◽

Vol 5 (4) ◽

pp. 265-269 ◽

Cited By ~ 18

Author(s):

Kamellia R. Dimitrova ◽

Darryl M. Hoffman ◽

Charles M. Geller ◽

Helbert DeCastro ◽

Bill Dienstag ◽

...

Keyword(s):

Radial Artery ◽

Artery Bypass ◽

Open Approach ◽

Open Technique ◽

Artery Graft ◽

Harvesting Technique ◽

Harvesting Techniques ◽

Cabg Patients ◽

Endoscopic Group

Objective A recent multicenter study reported reduced patency of aortocoronary bypass grafts when the saphenous vein was harvested by endoscopic technique compared with patency of vein grafted after harvest by the traditional “open” approach. Our aim was to compare the patency rates of radial artery graft (RAG) harvested endoscopically with those harvested using an open technique. Methods Two cohorts were identified: from January 1995 to January 2000, 724 consecutive patients had one or both radial arteries harvested through an open technique, and from February 2000 to January 2008, 727 consecutive patients had endoscopic radial artery (RA) harvest. All patients who underwent symptom-indicated angiography in our institution at any time after coronary artery bypass grafting (CABG) surgery were identified. Results Two hundred two patients had angiograms for symptoms: 90 of these patients (119 RAG) had open RA harvest and were studied 78.3 ± 40 months (range, 1–156 months) after CABG. The other 112 patients (148 RAG) had endoscopic RA harvest and underwent angiography 36 ± 24 months (range, 1–96 months) after CABG. The two groups had identical demographics and risk profiles. Overall patency of the “open” RAG was 78.9% versus 83.7% for the endoscopic group (P = 0.3). Patency increased to 90% in both groups when the RAG was anastomosed to a native coronary vessel with stenosis >80%. Conclusions Endoscopic and open RA harvesting techniques have equivalent and excellent midterm and long-term patency rates in CABG patients studied by angiography for recurrent symptoms of myocardial ischemia. The degree of stenosis of the target vessel strongly influences the patency rate independent of the harvesting technique.

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