OBJECTIVE This study was undertaken to examine the clinical feasibility of a newly developed video-assisted endoscopic technique (Saitama-Olympus technique) to harvest saphenous vein graft (SVG) in 40 CABG patients. METHODS There were 37 males and three females with an average age of 59+/-11 years. The special instruments developed were optical sheath, solid dilators, tunnel retractor, vessel dissector, GCC forceps which were utilized in conjunction with the thoracoscopic surgery system (Olympus, Tokyo, Japan). The course of the saphenous vein (SV) was marked on the skin prior to operation. SV was identified in the femoral region with a 4-cm skin incision and dissected with an open technique. The anterior surface of SV was dissected for 30 cm by the optical sheath mounted on the endoscope. Then another 4-cm skin incision above SV was placed in the popliteal region, resulting in a subcutaneous space over the SV. The subcutaneous space was then dilated and maintained with the tunnel retractor which has an endoscope channel at the top. With this system SV was visualized stably by endoscope without any assistance. All side branches were dissected and divided with the vessel dissector. When longer SVG is required, the same procedure was extended to the ankle with additional one or two skin incisions. RESULTS SV was easily harvested in all patients with spending 15-84 min. The average number of skin incisions was 2.4+/-0.5 and the average length of the harvested SVG was 41+/-12 cm. The average number of bypassed grafts was 3.4+/-1.0 with use of left internal mammary artery (IMA) in 31 patients. The average operation time was 272+/-52 min, there were no significant prolongation relating to endoscopic SVG harvesting. The remainder of SVG in each patients was pathologically examined and there were no evidence of intimal injury. There were no major wound complications during the average follow-up of 10+/-4 months and this technique seemed to be advantageous for patients with less wound pain and better cosmetic appearance. CONCLUSIONS The Saitama-Olympus technique to endoscopically harvest the SV is a clinically feasible surgical technique with the unique potential of a significant reduction in morbidity and decreased wound scarring in CABG patients.