Microsurgical procedures are performed on parts of the body that are best visualized under a surgical microscope. Examples of such structures are small blood vessels, nerves, and tubes. Microsurgery uses techniques that have been performed by surgeons since the early twentieth century, such as blood vessel repair and organ transplantation, but under conditions that make traditional vascular surgery difficult or impossible.
The first microvascular surgery, using a surgical microscope to aid in the repair of blood vessels, was described by Jules Jacobson of the University of Vermont in 1960. The first successful replantation or reattachment of an amputated body part was reported in 1964 by Harry Bunke. This replantation of a rabbits ear was significant because blood vessels smaller than 0.04 inch similar in size to the blood vessels found in a human hand, were successfully attached by microscope surgery. Two years later, the successful replantation of a toe to the hand of a monkey was made possible by using microscope surgery and microsurgical techniques. Soon thereafter, microsurgery began being used in a number of clinical settings.
Numerous surgical specialties utilize the techniques of microsurgery. Otolaryngologists are doctors who specialize in ear, nose, and throat doctors, perform microsurgery on the small, delicate structures of the inner ear or the vocal cords. Cataracts are removed by ophthalmologists or eye doctors, who also perform corneal transplants and treat eye conditions like glaucoma. Urologists can reverse vasectomies or male sterilization, and gynecologists can reverse tubal ligations or female sterilization, giving people new choices about having children. Microsurgical techniques are used by plastic surgeons to reconstruct damaged or disfigured skin, muscles, or other tissues, or to transplant tissues from other parts of the body. And, importantly, a number of specialties can collaborate to treat patients who have limbs or other body parts; under certain circumstances, amputated parts can be reattached, or another body part can be replanted in the patient with the help of microscope surgery. Today, microsurgery can be lifesaving. Neurosurgeons can treat vascular abnormalities found in the brain, and cancerous tumors can be removed.
Microsurgical equipment magnifies the operating field, provide instrumentation precise enough to maneuver under high magnification, and allow the surgeon to operate on structures barely visible to the human eye with use of high-powered surgical microscopes. The most important tools used by the microsurgeon are the microscope, microsurgical instruments, and microsuture materials.
While operating surgical microscopes may differ according to their specific use, certain features are standard. The microscope may be floor or ceiling mount, with a moveable arm that allows the surgeon to manipulate the microscope’s position. A view of the surgical site is afforded by a set of lenses and a high-intensity light source. This lighting is enhanced by maintaining a low level of light in the rest of the operating room. Two or more sets of microscope lenses allow a surgeon and an assistant to view the operating field and focus and zoom independently. A video camera allows the rest of the surgical team to view the operating field on a display screen. Features that come on some microscopes include foot and/or mouth switch controls and motorized zoom and focus.
A magnification of five to forty times is generally required for microsurgery. A lower magnification may be used to identify and expose structures, while a higher magnification is most often used for microsurgical repair. Alternatively, surgical loupes or magnifying lenses mounted on a pair of eyeglasses may be used for lower magnifications.
Microsurgical instruments differ from conventional instruments in a number of ways. They must be capable of delicately manipulating structures barely visible to the naked eye, but with handles large enough to hold comfortably and securely. They must also take into account the tremor of the surgeon’s hand, greatly amplified under magnification.
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