Maquet VASOVIEW 7, Руководство по обучению, Страница: 15 / 40

15 | | MAQUET Medical Systems USA | ENDOSCOPIC VESSEL HARVESTING |
VASOVIEW 7 | Training Manual | English | v1
Copyright MAQUET Gmbh
Step 2: posterior dissection
Withdraw the Endoscope to the tip of the BTT. Repeat
dissection along the posterior aspect of the vein, using a
gentle forward motion, until reaching the distal end of the
tunnel. (Figure 17) Note the further benefit of CO
2
insufflation
in separating tissue planes.
Technique Tips
Maintain the Dissection Tip close to the posterior vein
surface when dissecting the surrounding tissue.
Advance the endoscope 180 degrees from the anterior
dissection which will help provide maximum dissection.
Watch for posterior branches and direct the Dissection Tip
around them to prevent an avulsion.
Step 3: branch dissection
Withdraw the endoscope to the BTT. Begin dissecting along
the vein, removing any remaining tissue that is still adhered.
(Figure 18) When a branch is encountered, dissect it with
short, controlled gentle probes with the Dissection Tip. Con-
tinue until all branches are adequately exposed to facilitate
cauterization and transection. (Figure 19)
Technique Tips
Be sure to expose each branch adequately, enabling easy
access when using the VASOVIEW 7 Harvesting Cannula.
Larger branches may require additional dissection to achieve
additional branch length. This will give increased distance
between the vein and the branch for later cauterization.
Try to dissect excess fat from the branch so that cauteriza-
tion energy will be directed to the branch rather than to the
avascular tissue, which may impede branch coagulation.
Until experience is gained, be careful not to advance the
endoscope too quickly when dissecting around branches.
External manipulation by your free hand will aid dissection
by bringing the tissue or branches to the Dissection Tip. As
experience level increases, this will become even more
beneficial.
Figure 17 Figure 18 Figure 19