Microsurgery

Techniques Used in Microsurgery

Essentially, microsurgery is the procedure done on very small and intricate structures like the blood vessels and the nerves.

The procedure is carried out using specialized instruments under a microscope.

Microsurgery also uses techniques that have been employed since the early part of the twentieth century.

Some of the techniques used include organ transplantation and blood vessel repair.

Several surgical specialties have used microsurgery techniques in the procedures they perform.

For instance:

  • Otolaryngologists (ear, nose, and throat doctors) – employs microsurgeries when working on the delicate and small structures found in the inner ear. Microsurgical techniques are also used when working on the vocal cords.
  • Ophtalmologists (eye doctors) – carries out microsurgery to do corneal transplants, remove cataracts, and treat other eye conditions like glaucoma.
  • Urologists and gynecologists – uses microsurgery principles when reversing vasectomies and tubal ligations.
  • Plastic surgeons – reconstructs disfigured or damaged tissues, muscles, and skin using techniques used in microsurgery.
  • Other specialties – microsurgery is performed to reattach or replant amputated body parts.

Techniques

Microsurgical procedures uses a set of techniques a surgeon needs to master.

These basic techniques include nerve repair and grafting, blood vessel repair, and vein grafting.

Nerve Repair

Anastomosis or neurorrhaphy is the process of connecting the two cut ends of a nerve.

Nerve repair can entail suturing of the epineurium or the perineurium only.

Vein Grafting

This procedure is the alternative to end-to-end anastomosis.

However, vein grafting is often only performed when attaching the cut ends of the blood vessels without any tension is not feasible.

Blood Vessel Repair

Vascular anastomosis is the process of connecting two different vessels to form a continuous channel.

Anastomoses may be end-to-side or end-to-end.

Nerve Grafting

The alternative procedure to end-to-end anastomosis is called vein grafting.

The procedure is often only used when the cut ends of the blood vessels cannot be attached without any tension.

Training

Surgeons who carry out microsurgeries are required to undergo extensive practice and training.

Knowledge of surgical techniques and basic anatomy are also considered crucial.

Additionally, surgeons will also need to be taught how to lessen hand tremors, how to maintain visual contact using the microscope, how to maintain proper posture during the procedure, and how to properly hold the instruments, among other things.

Once the surgeon has become highly proficient in the basic skills required in microsurgery, advanced techniques like treating specific conditions will be taught.

Equipment

Key purposes of equipment used in microsurgery include providing instrumentation and magnifying the operating field.

The equipment used have also been designed to ensure precise maneuvering is possible.

Essential instruments needed in microsurgery include the microscope, micro suture materials, and microsurgical instruments.

Microscope

Microscope utilized in microsurgery is either mounted on the floor or on the ceiling.

It also comes equipped with a moveable arm so manipulating its position is a lot easier.

A high-intensity light source and a set of lenses are used to make viewing the surgical site possible.

Typically, microsurgical procedures use a microscope with five to forty times (5–40x) magnification.

Instruments

Compared to surgical instruments used for traditional surgery, instruments used in microsurgery have other distinct features.

Apart from their ability to manipulate structures that are barely visible, microsurgical instruments also have large handles so it can be handled as securely and as comfortably as possible.

Some of the instruments used in microsurgery include:

  • Forceps
  • Needle Holders
  • Scissors
  • Irrigators
  • Vessel Dilators

Suture Materials

Stitching or suturing is done using specialized needles and threads.

The diameter of the thread will vary in size and will depend on the procedure that will be carried out and the tissue that needs suturing.

Suture threads are either made from natural materials or synthetic ones. They can also be absorbable or non-absorbable.

Likewise, suture needles can also come in diverse shapes and sizes.

They can also come with different point types.

Typically, needles that are less than 0.15 mm in diameter are used.

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