Optical Magnification Should Be Mandatory for Microsurgery: Scientific Basis and Clinical Data Contributing to Quality Assurance

 

 Permissions and Reprints

Background Microsurgical techniques are considered standard procedures in reconstructive surgery. Although microsurgery by itself is defined as surgery aided by optical magnification, there are no guidelines for determining in which clinical situations a microscope or loupe should be used. Therefore, we conducted standardized experiments to objectively assess the impact of optical magnification in microsurgery.

Methods Sixteen participants of microsurgical training courses had to complete 2 sets of experiments. Each set had to be performed with an unaided eye, surgical loupes, and a regular operating microscope. The first set of experiments included coaptation of a chicken femoral nerve, and the second set consisted of anastomosing porcine coronary arteries. Evaluation of the sutured nerves and vessels were performed by 2 experienced microsurgeons using an operating microscope.

Results The 16 participants of the study completed all of the experiments. The nerve coaptation and vascular anastomoses exercises showed a direct relationship of error frequency and lower optical magnification, meaning that the highest number of microsurgical errors occurred with the unaided eye. For nerve coaptation, there was a strong relationship (P<0.05) between the number of mistakes and magnification, and this relationship was very strong (P<0.01) for vascular anastomoses.

Conclusions We were able to prove that microsurgical success is directly related to optical magnification. The human eye's ability to discriminate potentially important anatomical structures is limited, which might be detrimental for clinical results. Although not legally mandatory, surgeries such as reparative surgery after hand trauma should be conducted with magnifying devices for achieving optimal patient outcomes.

Publication History

Received: 09 August 2012

Accepted: 02 January 2013

Article published online:
01 May 2022

© 2013. The Korean Society of Plastic and Reconstructive Surgeons. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonCommercial License, permitting unrestricted noncommercial use, distribution, and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes. (https://creativecommons.org/licenses/by-nc/4.0/)

Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA

• REFERENCES

• 1 Rohrich RJ, Rosen J, Longaker MT. So you want to be an innovator?. Plast Reconstr Surg 2010; 126: 1107-1109
  CrossrefPubMedGoogle Scholar
• 2 Kleinert HE, Kasdan ML. Restoration of blood flow in upper extremity injuries. J Trauma 1963; 3: 461-476
  CrossrefPubMedGoogle Scholar
• 3 Shenaq SM, Klebuc MJ, Vargo D. Free-tissue transfer with the aid of loupe magnification: experience with 251 procedures. Plast Reconstr Surg 1995; 95: 261-269
  CrossrefPubMedGoogle Scholar
• 4 Neaigus A. The network approach and interventions to prevent HIV among injection drug users. Public Health Rep 1998; 113 Suppl 1 140-150
  PubMedGoogle Scholar
• 5 Agarwal A. In: Agarwal S, Agarwal A, Apple DJ. et al. Visual acuity. Textbook of opthalmology. 2002. New Delhi: Jaypee Brothers Medical Publishers Ltd.; 157-158
  Google Scholar
• 6 Sucur D, Konstantinovic P, Potparic Z. Fresh chicken leg: an experimental model for the microsurgical beginner. Br J Plast Surg 1981; 34: 488-489
  CrossrefPubMedGoogle Scholar
• 7 Schoffl H, Kropfl A. Alternatives to laboratory animals in microsurgical training. ALTEX 1994; 11: 32-39
  PubMedGoogle Scholar
• 8 Schoffl H, Froschauer SM, Dunst KM. et al. Strategies for the reduction of live animal use in microsurgical training and education. Altern Lab Anim 2008; 36: 153-160
  CrossrefPubMedGoogle Scholar
• 9 Schoffl H, Hager D, Hinterdorfer C. et al. Pulsatile perfused porcine coronary arteries for microvascular training. Ann Plast Surg 2006; 57: 213-216
  CrossrefPubMedGoogle Scholar
• 10 Carrel D. Operative technic of vascular anastomoses and visceral transplantation. Lyon Med 1964; 212: 1561-1568
  PubMedGoogle Scholar
• 11 Hopfner E. Uber gefassnaht, gefasstransplantation und replantation von amputierten extremitaten. Arch Klin Chir 1903; 70: 417-471
  Google Scholar
• 12 Guthrie CC. Blood-vessel surgery and its applications. 1912. New York: Edward Arnold-London;
• 13 Splinter R, Hooper BA. An introduction to biomedical optics. 2007. London: Taylor & Francis;
• 14 van Zuylen J. The microscopes of Antoni van Leeuwenhoek. J Microsc 1981; 121: 309-328
  CrossrefPubMedGoogle Scholar
• 15 Louw DF, Sutherland GR, Schulder M. From microscopic to astronomic, the legacy of Carl Zeiss. Neurosurgery 2003; 52: 668-674
  CrossrefPubMedGoogle Scholar
• 16 Nylen CO. The microscope in aural surgery, its first use and later development. Acta Otolaryngol Suppl 1954; 116: 226-240
  Google Scholar
• 17 Jacobson JH, Suarez EL. Microsurgery in anastomosis of small vessels. Surg Forum 1960; 11: 243-245
  Google Scholar
• 18 Komatsu S, Tamai S. Successful replantation of a completely cut-off thumb. Plast Reconstr Surg 1968; 42: 374-377
  CrossrefGoogle Scholar
• 19 Daniel RK, Taylor GI. Distant transfer of an island flap by microvascular anastomoses: a clinical technique. Plast Reconstr Surg 1973; 52: 111-117
  CrossrefPubMedGoogle Scholar
• 20 Chan WY, Matteucci P, Southern SJ. Validation of microsurgical models in microsurgery training and competence: a review. Microsurgery 2007; 27: 494-499
  CrossrefPubMedGoogle Scholar
• 21 Kazemi H, Rappel JK, Poston T. et al. Assessing suturing techniques using a virtual reality surgical simulator. Microsurgery 2010; 30: 479-486
  CrossrefPubMedGoogle Scholar
• 22 Carlson ML, Archibald DJ, Sorom AJ. et al. Under the microscope: assessing surgical aptitude of otolaryngology residency applicants. Laryngoscope 2010; 120: 1109-1113
  CrossrefPubMedGoogle Scholar
• 23 Chan W, Niranjan N, Ramakrishnan V. Structured assessment of microsurgery skills in the clinical setting. J Plast Reconstr Aesthet Surg 2010; 63: 1329-1334
  CrossrefPubMedGoogle Scholar
• 24 Chan WY, Figus A, Ekwobi C. et al. The 'round-the-clock' training model for assessment and warm up of microsurgical skills: a validation study. J Plast Reconstr Aesthet Surg 2010; 63: 1323-1328
  CrossrefPubMedGoogle Scholar