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At least 19 recordsLinked to original sources
PubMed2001

Video microsurgery: evaluation of standard laparoscopic equipment for the practice of microsurgery.

Traditional microsurgery involves the use of bulky and expensive stereo microscopes that have limited portability. Recent advances in video technology have enabled the exploration of alternative visualization methods. The purpose of this study was to evaluate standard laparoscopic equipment for microvascular anastomoses. Eight surgeons completed anastomoses on rat femoral and synthetic vessels using stereo microsurgery and video microsurgery visualization systems. All surgeons had previous experience with stereo microsurgery and none had ever used video microsurgery. Data were collected on overall anastomosis and individual suture times. A sample of completed anastomoses was placed in a video database and evaluated by use of a quality rating scale (8 to 10, excellent; 6 to 7, adequate; less than 6, poor). All surgeons subjectively evaluated the video microsurgery system. A total of 48 anastomoses were completed. The average total anastomosis time for the stereo microsurgery was 1018.9 +/- 463.2 seconds versus 1738.9 +/- 460.1 seconds for the video microsurgery. The average individual suture placement time was 114.6 +/- 60.6 seconds for the stereo microsurgery versus 211.7 +/- 128.4 seconds for the video microsurgery (p < 0.05). Twenty-five of the anastomoses underwent quality review. The overall score of the stereo microsurgery group was 8.1 +/- 1.7, and the video microsurgery group had an overall score of 7.3 +/- 1.6. Survey results revealed that 75 percent of the participants thought that the video microsurgery would be useful for human operations and would improve surgeon comfort, but 87.5 percent would not use the present video microsurgery system over stereo microsurgery in their practice. Although significant differences exist in overall anastomosis and individual suture completion times, no difference was found in the overall quality. Video microsurgery could become a useful tool on the basis of surgeon ergonomics; however, optical parameters require further refinement.

Anastomosis, Surgical↗
PubMed1988

Microsurgery in China and the development of Western reconstructive microsurgery.

The development of extremity replantation and reconstructive microsurgery was initially carried out independently among the pioneering centers throughout the world. The comparative development of these techniques is outlined. With the fast growth of microsurgical procedures, many of the U.S. residency programs have incorporated microsurgery training into the curriculum.

Australia↗
PubMed2003

Endoscopic-assisted microsurgery: microsurgery in the new millennium? A comparative experimental study.

Endoscopes are already present in almost all plastic surgery departments. The operating microscope is currently an essential piece of equipment for performing microsurgical anastomoses; however, microsurgery could be conducted using other equipment, including the endoscope. By performing 60 vessel and nerve repairs in rats under the operating microscope and the same number using the endoscope as a visual aid, we investigated the technical and clinical differences between the two instruments. We recorded significantly shorter operative, vascular preparation and anastomotic times in the endoscopically assisted group. Based on the data collected during this study, we conclude that microsurgery is possible with the aid of an endoscope. Using the endoscope may make prolonged microvascular procedures shorter and less physically demanding and may increase the comfort level of both the surgeon and the assistant.

Anastomosis, Surgical↗
PubMed1981

[Organization of microsurgery in France: application of microsurgery in orthopedics].

Microsurgery in France is organized in a relatively large number of centers. More centers would compromise the results achieved especially in replantation. Teaching and training is given in specialised courses and at universities. Indications for microsurgery in orthopaedics and traumatology are widespread. Large replantations may give excellent results but frequent complications have to be kept in mind, which sometimes are live-threatening. Free or composite grafts of skin, toe, muscles, bone and joints with neurovascular peduncle may be taken into consideration.

Adult↗
PubMed1977

Congenital glaucoma before and after the introduction of microsurgery. Results of "macrosurgery" 1943-1963 and of microsurgery (trabeculotomy/ectomy) 1970-1974.

Primary trabeculotomy (in five eyes "converted" to trabeculectomy) normalized the tension in all 21 eyes with congenital glaucoma without associated diseases, (mean postoperative tension 12 mmHg, range 8-20 mm). Re-operation was needed for only one eye. Preoperatively glaucomatous cupping was present in 18 of these 21 eyes. Ten of the 18 eyes with glaucomatous cupping were operated upon before the age of 6 months two before 11 months and the appearance of the disc was normalized in these 12 eyes. Repeated trabeculotomy, -ectomy was without success in three of five operated eyes in patients with congenital glaucoma of several years duration previously treated by "macrosurgery". In patients with associated diseases normal tension was achieved by means of trabeculotomy/-ectomy in two eyes in two Sturge-Weber children with unilateral congenital glaucoma and in both eyes in a child with a chromosomal defect with bilateral congenital glaucoma. Repeated trabeculotomy/ectomy was on the other hand without success in a child with bilateral aniridia with congenital glaucoma and hydrocephalus. Presupposing acute or subacute microsurgery, the present operative results of congenital glaucoma without diseases are far better than those obtained in previous decades by "macrosurgery" which, despite frequent re-operations, effected normalization of the tension in only 61% of the eyes (11 of 26 patients (42%) with bilateral congenital glaucoma without associated diseases and treated by macrosurgery in previous decades were under the Care of the Blind).

Denmark↗
PubMed2004

[Radiosurgery of vestibular schwannomas after microsurgery and combined radio-microsurgery].

Significant morbidity is expected after microsurgery for recurrent or growing residual vestibular schwannoma (VS). In order to avoid this procedure, radiosurgery appeared as an interesting alternative. The purpose of this study is to analyze the results of Gamma Knife radiosurgery in this indication. Between July 1992 and January 2002, 60 patients (including 12 NF2 patients) underwent radiosurgical treatment after one or more attempts of surgical resection (including 27 growing remnant VS and 19 recurrent VS) and could be followed with enough informations, out of 103 patients (10% of the VS population treated during the same period). Mean interval between surgical removal and radiosurgery was 71.5 Months (1.8-127.8 Months). Technical difficulties during the procedure were observed in the 12 cases, mainly due to problems in identifying the target. Median follow-up was 51.6 Months. Four out of 58 patients (7%, confidence interval: 1.9-16.7) were diagnosed as failure. Statistical study failed to find significant parameters influencing failure. Facial and trigeminal nerves were not impaired while one case of severe bulbopontine radio-induced injury leading to a lower cranial nerve deficit was observed. These results show that, in spite of additional difficulties to treat these patients with radiosurgery, this treatment is efficient with acceptable morbidity and can avoid another microsurgical procedure. The strategy of planned combined micro-and radiosurgical treatment of large VS deserves additional investigations to be validated.

Adult↗
PubMed1995

Microsurgery without a microscope: laboratory evaluation of a three-dimensional on-screen microsurgery system.

In microvascular surgery, procedures may be both technically and physically demanding. Precise movements sustained over long hours in addition to typically compromised surgeon and assistant positioning lead quickly to physical and mental fatigue. Many of the positioning problems encountered are related to the fact that the eyes of the surgeon must be continually fixed to the microscope eyepieces. This study explores a possible solution: a microscope system that eliminates the need to view the operative field through the microscope eyepieces. A Three-dimensional On-screen Microsurgical System (TOMS) was used and contrasted with conventional operative microvascular surgery in the laboratory setting. The surgeon's comfort, his ability to instruct microsurgical technique, pertinent technological performance, and the procedure itself were evaluated using a standardized questionnaire. Based on data collected in this study, we conclude that divorcing the surgeon's eyes from the microscope eyepieces using the TOMS may make prolonged microvascular procedures less physically demanding and may increase the comfort level of both the surgeon and his assistant, although refinements to the technology are required.

Anastomosis, Surgical↗
PubMed2000

[Microsurgery of lumbar disc prolapse. Superior results of microsurgery as compared to standard- and percutaneous procedures (review of literature)].

In a meta-analysis of 69 prospective and retrospective studies, we investigated the value of various surgical techniques in the treatment of lumbar disk herniations. This analysis includes standard diskectomy (5080 patients from nine series), microdiskectomy (5354/23), and comparison of both techniques (2494/10) and furthermore chemonucleolysis (2729/16), laser therapy (881/3), percutaneous nucleotomy (3506/18), comparisons of percutaneous techniques (942/5) with microdiskectomies (561/5) and standard diskectomies (1020/6). Outcomes were rated according to Macnab's criteria: I "excellent", II "good", III "improved", IV "same as before", V "worse", I/II "markedly improved", III "partially improved", IV/V "not improved", I-III "successful", and IV/V "unsuccessful". Results after microdiskectomy were "successful" more often (90% vs. 95%), "good/excellent" more often (82% vs. 73%), and patients left the hospital sooner than with standard diskectomy. Recurrence rates were comparable (4%). Results of both open techniques were clearly superior to those from any type of percutaneous treatment: chemonucleolysis und laser therapy were "successful" in 69% and 70% of cases respectively, with recurrence rates of 17% and 18%, endoscopic nucleotomy was "successful" in 84% of cases, and recurrence rate was 14%. Please ask the author for the reference database.

Diskectomy↗
PubMed1999

Video-microsurgery: a new tool in microsurgery.

Endoscopic surgery is slowly becoming an increasing part of plastic surgical practice. Besides its most obvious advantages, related to small incisions, the endoscope provides excellent magnification of the operative field. We thus decided to investigate the possibility of using the endoscope as an alternative to the operative microscope for performing microsurgical procedures. Before starting a clinical investigation, digital artery, nerve, vein microsutures, and neck dissections were performed in fresh human cadavers. Magnification, working distance, depth of focus, diameter and temperature of the operative field, and resolution were measured using either the operating microscope or the endoscope. Working conditions were compared. The advantages of the endoscope as compared to the microscope were: less bulk, sterility, mobility, versatility and cost-effectiveness. The disadvantages were: short working distance, inferior resolution and two-dimensional images. Overall, the endoscope was found to be an interesting alternative to the operating microscope. We are now using the endoscope routinely in the clinical arena, and we believe that it has a great potential and a promising future as a microsurgical tool.

Endoscopes↗
PubMed2001

Experimental microsurgery of salivary ducts in dogs.

The results achieved by experimental microsurgical suturing of salivary ducts in dogs are presented. Nine partial lesions and one complete transection of the ducts were made on parotid and submandibular ducts. Four to seven interrupted microsutures were used for each lesion. The operations were successful in seven out of 10 cases, as observed by sialography. Histologically, granulation tissue compressing the ducts was observed after suturing the lesions. Four venous graft transplantations were performed and none were successful. After venous graft transplantation, the transplant was not apparent histologically, raising doubt as to the potential success of this technique. The use of stenting is discussed based on a summary of the published literature. Those reports indicate that long-term stenting can benefit the outcome of salivary duct repair. The use of dogs as a model for experimental salivary duct operations has been shown to be valuable in assessing various surgical techniques. Copyright 2001 European Association for Cranio-Maxillofacial Surgery.

Journal Article↗