Maquet VASOVIEW 7, Руководство по обучению, Страница: 21 / 40

21 | | MAQUET Medical Systems USA | ENDOSCOPIC VESSEL HARVESTING |
VASOVIEW 7 | Training Manual | English | v1
Copyright MAQUET Gmbh
Figure 29a Figure 30 Figure 29b
diSTal TranSEcTiOn and ligaTiOn
Distal ligation can be performed in various ways. A “stab
and grab” approach is used to externalize the vein through a
stab wound. It is then transected externally. An “endoloop”
approach divides the vein endoscopically, and is a technique
used by some experienced users.
“Stab and grab”
With the tunnel insufflated, make a small 1–3 mm stab wound
using an 11 blade over the distal end of the tunnel. The distal
end of the tunnel can be identified with external manipulation.
Observe on the video monitor as a hemostat or similar small
clamp is inserted through the stab wound and advanced into
the tunnel. (Figures 29a and 29b) Under endoscopic vision,
place the clamp across the distal end of the vein. Externalize
the vein through the stab wound and divide it under direct
vision per surgical protocol. (Figure 30) Allow the harvested
vein segment to retract back into the tunnel. Ligate the ter-
minal end of the vein stump per hospital protocol. Allow the
ligated vein stump to retract back into the tunnel.
Endoloop approach
This technique for performing distal ligation without the use
of skin incisions uses a knot pusher to pass a suture loop to
the distal tunnel. (Appendix A shows the steps for creating a
ligation loop.)
running THE VEin
The purpose of running the vein is to identify any missed
branches or tissue prior to distal vessel transection.
Once all branches have been cauterized and transected, run
the C-Ring along the entire length of the vein to ensure that
all branches have been transected.
Make a second pass with the C-Ring in the opposite
orientation to ensure that all branches and connective tissue
are free from the vessel. (Figure 28)
Identify and divide any connective tissue or branches that
are still adhered to the vein.
Figure 28