Surgery performed on the nerves and the blood vessels (or other very small structures) utilizing specialized instruments under a microscope is called microsurgery.
The procedure makes use of certain techniques like blood vessel repair and organ transplantation. The techniques have been used since the early twentieth century.
Techniques Used in Microsurgery
Microsurgery techniques have been employed by diverse surgical specialties including:
- Ophthalmologists (eye doctors) – treat glaucoma (and other eye conditions), remove cataracts, and perform corneal transplants using microsurgery.
- Gynecologists – reverses tubal ligations using microsurgery techniques.
- Urologists – reverses vasectomies using microsurgery principles.
- Otolaryngologists (ear, nose, and throat doctors) – perform microsurgeries when they need to do work on the intricate and minute structures of the ear.
- Other specialties – makes use of microsurgery to replace or reattach amputated parts (for instance, a damaged thumb is replaced with a great toe).
Instruments Used in Microsurgery
Microsurgical instruments help by providing instrumentation, magnifying the operating field, and making it possible for the surgeon to do surgery on structures that are barely visible to the naked eye.
Microsurgical materials, microscope, and microsurgical instruments are considered the most essential tools when performing microsurgery.
Operating microscopes can differ depending on their specific use.
However, it’s safe to assume they have common standard features.
The microscope used for microsurgery can be mounted either on the ceiling or on the floor. Also, it comes equipped with a moveable arm that makes it possible for the surgeon to easily manipulate its position.
A set of lenses (together with a high-intensity light source) makes it feasible for the surgeon to view the site that needs to be operated on. A video camera will make it possible for the rest of the members of the surgical team to view the surgical site.
Ideally, a five to forty times (5–40x) magnification is needed when performing microsurgery.
However, in some cases, a lower magnification is utilized when identifying or exposing structures. For microsurgical repairs, a higher magnification is necessary.
Microsurgical instruments are designed so delicately manipulating structures is made possible. They also come equipped with handles that are large enough so handling them comfortably and securely is feasible.
Instruments that are used in microsurgery include:
- Needle holders
- Vessel dilators
- Vascular clamps
Suturing and stitching is done using specialized threads and needles. In most cases, needles with 9–0 to 12–0 gauges are used in the procedure. The diameter (gauge) however will depend on the tissue that needs suturing and the procedure to be done.
On the other hand, suture threads can be synthetic or natural. It can also be absorbable or non-absorbable. Just like the suturing needle, the kind of suture thread that will be used in microsurgery will also depend on the procedure and the tissue that will sutured.
Essential Techniques Employed in Microsurgery
Vein grafting is an alternative procedure to end-to-end anastomosis. However, the procedure is only resorted to when it is impossible to attach the cut ends of the blood vessels without any tension.
When there is a large gap between the nerves that have been cut, tension is created. In similar cases, neurorrhaphy is not performed since it might end up interfering with the postsurgical function of the patient.
Blood vessel repair
When two different vessels are connected to form a continuous channel, the procedure is called vascular anastomosis. Anastomoses may be end-to-end or end-to-side.
When the ends of two nerves that have been cut are connected, the procedure is called neurorrhaphy or anastomosis. Nerve repair may involve suturing of the epineurium or the perineurium only.