Microsurgery: Basic Principles

In essence, microsurgery is surgery performed on very small structures (i.e. nerves and the blood vessels).

Specialized instruments under a microscope are also used for the procedure.

Microsurgery makes use of techniques like blood vessel repair and organ transplantation.

The aforementioned techniques have been used since the twentieth century’s early part.

Microsurgery techniques have also been utilized by several surgical specialties.

For instance:

Ophthalmologists (eye doctors)

Performs microsurgery to remove cataracts, carry out corneal transplants, and treat glaucoma and other eye conditions.

Otolaryngologists (ear, nose, and throat doctors)

Uses microsurgeries when working on the small and delicate structures of the inner ear or when carrying out work on the vocal chords.

Gynecologists and urologists

Reverses tubal ligations and vasectomies using microsurgery principles.

Plastic surgeons

Reconstructs damaged or disfigured skin, tissues, and muscles using microsurgical techniques.

Other specialties

Performs microsurgery to replant or reattach amputated body parts to replace a new one (for instance, a lost or damaged thumb is replaced with a great toe).

Equipment Used in Microsurgery

The key functions of microsurgical equipment include magnifying the operating field and providing instrumentation.

The equipment used are designed to make precise maneuvering feasible and to make operating on barely visible structures possible.

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

Microscope

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

It also comes designed with a moveable arm so manipulating its position becomes relatively easier.

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

A video camera is used so other members of the surgical team can view the surgical site on a display screen.

Ideally, a five to forty times (5–40x) magnification is used in microsurgical procedures.

Instruments

Compared to traditional surgical instruments, those used in microsurgery have distinct differences.

Aside from its capability to delicately manipulate barely visible structures, microsurgical instruments also come with handles that are large enough so handling them comfortably and securely is possible.

Instruments often utilized in microsurgery include:

• Needle holders (for suturing)
• Forceps
• Vessel dilators
• Standard surgical tools
• Scissors
• Irrigators

Suture Materials

In microsurgery, suturing or stitching is carried out utilizing needles and threads that are specialized.

The diameter or gauge of the threads can vary in size.

When choosing the apt thread to be used, the procedure that will be performed as well as the tissue that needs to be sutured will be taken into account.

In most cases, threads with 9–0 to 12–0 gauges are used in microsurgery.

Suture threads can also be non-absorbable or absorbable.

They can also be made from natural materials or synthetic ones.

The type used will depend on the procedure as well as the tissue that needs suturing.

Suture needles come in diverse sizes and shapes.

They also have different point types.

Generally, however, the needles often used are less than 0.15 mm in diameter.

Training

Surgeons will have to undergo extensive training and practice before they perform microsurgery.

Know-how on basic anatomy and surgical techniques will also be required.

Surgeons will also be taught how to hold the instruments properly, how to lessen hand tremors, ways to maintain proper posture when performing microsurgical procedures and maintaining visual contact when using the microscope, among other things.

A set of essential techniques have to be mastered by the surgeon as they are often utilized in microsurgery.

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

When already very proficient in the basic skills needed for microsurgery, more advanced techniques will be taught, including treating specific conditions.

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source http://allurewellness.net/2017/01/31/microsurgery-basic-principles/