EVH Hands On
You have a brand new EVH account and you are there to train a new harvester on the inanimate leg
model. The harvester will be doing their first EVH case tomorrow morning. You choose the
VASOVIEW EVH System. (VV6 PRO, VV7 xB, HEMOPRO, or HEMOPRO 2) For this activity, you
are to train this new EVH harvester using the leg model, instructing them on everything from set up of all
equipment to completion vessel harvesting through vein preparation. You will be assessed on all aspect
.
Equipment Set-up
1. Discuss the components of the EVH tower that are necessary to perform EVH
2. Discuss the cautery and foot pedal requirements (VV6 PRO or VV7)
3. Discuss the need for the HEMOPRO generator including appropriate settings, Extension Cable / Adaptor
Cable (HEMOPRO and HEMOPRO 2)
4. Discuss the connection of the tower equipment.
5. Discuss the danger of the light source and possible burn/fire.
6. Discuss/demonstrate connecting the Dissection Tip to the endoscope
7. Discuss/demonstrate back loading the BTT onto the endoscope and the different BTT seals
8. Discuss/demonstrate white balance and focus of the camera
Initial Incision and Vein Location
1. Discuss positioning the patient
2. Discuss the ways to locate the vein
3. Discuss different incision types
4. Discuss incision location options
5. Explain importance of creating a hood (anterior space) over the vein at the incision site
Dissection
1. Identify and point out the vein on the monitor
2. Identify and point out the conical dissection tip on the monitor
3. Identify and point out the correct surgical plane (anterior, posterior, lateral)
4. Discuss the correct steps of dissection per the IFU working from proximal to distal and then back to the
BTT after each step
- anterior
- posterior
- branch dissection
5. Identify and point out branches during dissection
6. Keep the harvester on the vein (avoid false tunnels)
7. Describe how to recognize “swirling” and the risk of vein perforation with the Dissection Tip
8. Discuss a strategy to troubleshoot when an issue presents itself (bleeding, tunnel collapse, vein transaction,
low light in tunnel, visual issues etc.)
Branch Cauterization and Transection
1. Demonstrate/discuss switching the system correctly (remove the Dissection Tip, change the BTT Seal, put
scope into the Harvesting Cannula, ensure it locks into place)
1. Discuss the settings for the bipolar cautery (diathermy) for VV6 PRO / VV7 or Power Supply for
HEMOPRO / HEMOPRO 2
2. If using the HEMOPRO or HEMOPRO 2, explain the CLAMP technique
3. Discuss/demonstrate “pre-testing” the Harvesting Tool on a saline soaked sponge prior to using the
Harvesting Tool
4. Explain that the Harvesting Tool should remain in the Harvesting Cannula while advancing the cannula into
the BTT and moving distally up the tunnel
5. Discuss/demonstrate the option of distal insufflation
6. Demonstrate the ability to negotiate the harvester through the tunnel
7. Discuss/demonstrate the importance of having the C-Ring distal to the branch
8. Discuss/demonstrate the ability to help the harvester maneuver the C-Ring to expose branch
9. Discuss the importance of length of branch in relation to main vein and the Harvesting Tool
10. Discuss/demonstrate the importance of the harvester “running the vein” prior to stab & grab
11. Discuss/demonstrate troubleshoot common issues that can occur during the EVH procedure (blood in
tunnel, tunnel collapse, visibility issues)
Vein Removal / Preparation
1. Discuss/demonstrate the “stab & grab” technique
2. Discuss that the vein should be prepared in its usual fashion, including tying/clipping side branches