# An Expert Panel Review of Endoscopic Vein Harvesting Devices: Benefits, Limitations, and Clinical Insights

## TL;DR

Experts review endoscopic vein harvesting devices, highlighting the need for better training and evidence-based evaluation to improve patient outcomes.

## Contribution

The paper provides expert consensus on EVH device limitations and training needs, emphasizing the lack of comparative studies and standardized practices.

## Key findings

- Learning curves for EVH range from 5 to 30 cases, but mastery may require over 100 cases.
- Device choice is often based on training and availability rather than clinical evidence.
- There is a need for independent device evaluation and standardized training programs.

## Abstract

Endoscopic vessel harvesting (EVH) devices are technically complex and the learning curve for novice practitioners can be steep, due to the need for refined hand-eye coordination and device familiarity. Training and mentoring approaches vary widely, as does the experience level of practitioners entering EVH practice.

This expert review was conducted by 10 international EVH specialists from the United Kingdom, United States, and Serbia, each with 18 to 28 years of experience. Comprehensive searches of EMBASE, Cochrane, PubMed, CINAHL, and Google Scholar revealed no head-to-head comparative studies of EVH devices. As a result, the group evaluated EVH device industry specifications and white papers to analyse the evolution, component features, and limitations of current systems. Expert consensus was also sought to outline ideal device attributes and training enhancements.

Studies suggest the EVH learning curve ranges from 5 to 30 cases; however, studies have reported that even after 100 cases, learning may be incomplete, particularly when assessed using optical coherence tomography for conduit injury. A lack of high-quality comparative studies and wide variability in device design, institutional practices, and user experience hinder conclusions about the superiority of any specific EVH system. Device choice is often based more on training background and availability than on clinical evidence.

No existing studies link specific device-related learning curves to clinical outcomes or conduit quality. There is an apparent need for independent device evaluation, standardized training programmes, and robust comparative outcome data to support evidence-based device selection that prioritizes patient safety and conduit long-term patency.

Coronary artery bypass graft (CABG) surgery is the gold standard treatment choice for multiple vessel or left main coronary artery disease (CAD).