Comparable Assessment of Perioperative and Postoperative Outcomes in Open Versus Endoscopic Radial Artery Harvest for Patients Undergoing CABG: A Systematic Review and Meta-Analysis

Coronary artery bypass grafting (CABG) is the standard treatment for multivessel coronary disease. The radial artery (RA) is commonly used because of its good long-term outcomes. RA can be harvested using either endoscopic or open techniques, but the optimal method remains unclear. This systematic review and meta-analysis compares outcomes between both approaches in CABG procedures. This systematic review and meta-analysis followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020 guidelines. PubMed, Embase, Cochrane Library, and Scopus were searched up to January 2026 for randomized controlled trials comparing endoscopic versus open RA harvesting in CABG. Data were analyzed using a random-effects model in R (version 4.5.2), with risk of bias 2 used for bias assessment. Outcomes assessed included wound and neurological complications, along with graft patency, mortality, and reoperation. Pooled analysis showed a significant reduction in wound infections (risk ratio, 0.58; P = 0.03) and neurological complications (risk ratio, 0.47; P < 0.0001) with endoscopic compared with conventional open harvesting, with consistent results across various follow-up periods. Graft patency showed similar results in both groups ( P = 0.49), with no significant differences in reoperation ( P = 0.33), in-hospital/30-day mortality ( P = 0.47), or length of hospital stay ( P = 0.16). However, endoscopic harvesting showed a significant increase in harvest time compared with open harvesting (mean difference, 11.44 minutes; P = 0.04), with no significant differences in aortic clamp time ( P = 0.96). Endoscopic RA harvesting in CABG surgery showed significantly reduced wound infections and neurological complications without affecting graft patency or short-term outcomes.