Endoscopic Vessel Harvesting System Training Manual

Introduction This training manual for endoscopic vessel harvesting (EVH) using the Vasoview 6 Pro Endoscopic Vessel Harvesting System is designed to provide the operator with step-by-step instructions for performing the EVH procedure. Included in this document are preoperative considerations, intra-operative technique tips, postoperative recommendations and troubleshooting suggestions. This document is not intended to replace reading the product Instructions for Use, nor is it intended to replace the independent judgment of the medical professional performing the procedure. Vasoview 6 Pro The...

6 Endoscopic Vessel Harvesting Procedure: 2 Endoscopic Vessel Harvesting Radial Artery 3 Operating Room Instrumentation and 5 Endoscopic Vessel Harvesting Procedure: Transection and Retrieval of the Radial 12 Appendix A: Eight Steps for Tying a Ligation

Endoscopic Vessel Harvesting Saphenous Vein Procedure-at-a-Glance Incision Create an incision in the area near the knee, over the greater saphenous vein. Attach the Dissection Tip to the end of the 7 mm endoscope. Insert the 7 mm endoscope into the incision and visualize on the video monitor. Advance the Short Port Blunt Tip Trocar (BTT) into position, and insufflate CO2 gas to create a tunnel. Perform anterior, posterior and branch dissection with the Dissection Tip. Cauterizing and Transecting Branches After removing the Dissection Tip from the endoscope insert the endoscope into the Vasoview...

Endoscopic Vessel Harvesting Radial Artery Procedure-at-a-Glance Incision Beginning just proximal to the wrist crease, create a longitudinal incision. Attach the Dissection Tip to the end of the 7 mm endoscope. Insert the 7 mm endoscope into the incision and visualize on the video monitor. Insert the Short Port Blunt Tip Trocar (BTT) into position and begin CO2 insufflation. Perform anterior, posterior, and lateral dissection of the radial artery pedicle with the Dissection Tip on the 7 mm endoscope. After removing the Dissection Tip from the endoscope insert the endoscope into the Vasoview 6...

Operating Room Instrumentation and Equipment Vasoview 6 Pro Endoscopic Vessel Harvesting System 7 mm Extended Length Endoscope Dissection Tip BiSector™ Tool 7 mm Endoscope Seal BiSector Toggle BiSector Carriage Short Port Blunt Tip Trocar (BTT) Port for distal insufflation Syringe for scope wash C-Ring (vessel cradle) Harvesting Cannula with built-in controls C-Ring (vessel cradle) slider Harvesting Cannula Seal Bipolar cord connector Port for scope wash CO2 Insufflation port with one-way valve Additional Items: • ipolar Cord (sterile) B • nti-fog solution A • urgical instruments used for open...

Equipment Testing • rior to starting the EVH procedure, turn on all of P the equipment on the video tower (video monitor, camera, light source, and insufflator). Be sure that the electric cords are attached to the back of each piece of equipment. Once all equipment checks are performed, turn the system completely off until the procedure begins. he monitor should show color bars until a camera T head is plugged into the camera box. If the color bars are not balanced, press the reset button to bring them back to the factory setting. he camera head should be plugged into the camera T box to check...

EVH Procedure Saphenous Vein Patient Positioning and Preparation Patient Positioning Place the patient in a supine position. Externally rotate the leg with the knee flexed and with support behind the knee and the thigh. (Figure 1) Surgical Preparation and Vein Location Prior to the skin prep, assess the patient to select the incision site around the knee area. Once the intended incision site is identified, mark the area with a surgical marker. The saphenous vein can usually be found by using anatomical landmarks. An ultrasonic doppler may be used to help locate the vein. If needed, use the doppler...

Product Assembly • ttach the 7 mm Extended Length Endoscope to the A camera coupler. Attach the light cable to the post on the endoscope. Focus the endoscope on a gauze pad and white balance the video camera as described below. Ensure proper orientation of the camera head. It is important to maintain correct orientation throughout the procedure. • hread the Dissection Tip to the distal end of the endoT scope until the proximal edge of the Dissection Tip lines up with the indicator etched on the endoscope shaft. (Figures 2 and 3) • nsert the endoscope with attached Dissection Tip I through the...

Incision Site Selecting the Incision Site There are several factors to consider when selecting the incision site, such as operator preference, number of grafts needed, and whether the upper or lower leg is used for the vein harvest. There are two commonly used incision sites: (Figure 6) • Below the knee: Palpate along the tibia until reaching the medial tibial epicondyle. Make a 2 cm incision along the posterior border of the tibial epicondyle. (Figure 7) • Above the knee: Make a 2 cm incision in the thigh where the vein lies in the groove between the sartorius and gracilis muscles. (Figure 8)...

Inserting the 7 mm Endoscope with Attachable Dissection Tip • nder direct visualization, insert the dissection tip U into the space created, and place it onto the anterior surface of the saphenous vein. (v) Note (on the video monitor) the color of the vein and the surrounding yellow fatty tissue. It is important to always identify the vein prior to advancement of the instrument. (Figure 9) If the vein is very superficial (adhered to the skin) or there is great resistance when advancing the Dissection Tip on the anterior surface of the vein, place the Dissection Tip on the posterior surface of...

onnect the CO2 insufflation tubing to the clear C flexible CO2 Insufflation Port on the BTT and begin insufflation of CO2. Ensure the CO2 Insufflator is set to the proper flow and pressure settings. CO2 Flow: 3 – 5 L/min CO2 Pressure: 10 – 12 mmHg The goal is to delineate a tissue plane for easier dissection and to maintain the tunnel. If desired pressure is not obtained in the tunnel, the slip tip syringe provided can be used to inflate the balloon on the BTT. Inflate the balloon with the minimal amount of air needed to create an adequate seal (0 – 25 cc’s of air). If there is obvious leakage...