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Journal of Reconstructive Microsurgery Mar 2022Among the many factors involved in reconstructive microsurgery, identifying a good recipient vessel is one of the key elements leading to a successful result.
BACKGROUND
Among the many factors involved in reconstructive microsurgery, identifying a good recipient vessel is one of the key elements leading to a successful result.
METHODS
Multiple modalities have been used to identify recipient vessels from simple palpation of axial arteries to hand-held Doppler, duplex ultrasound, computed tomography angiograms, and other advanced techniques. Although these various modalities bring their own unique advantages, using the duplex ultrasound can provide far superior and real-time information based on the anatomy and physiology of the recipient vessel.
RESULTS
Duplex ultrasound is a valuable and powerful tool for reconstructive surgeons who are interested in performing microsurgery or supermicrosurgery.
CONCLUSION
As we enter the era of individualized/customized reconstruction using superthin flaps, perforator-to-perforator anastomosis, and supermicrosurgery, understanding and becoming versatile with duplex ultrasound will be critical especially in choosing recipient vessels.
Topics: Anastomosis, Surgical; Microsurgery; Plastic Surgery Procedures; Surgical Flaps; Ultrasonography, Doppler, Duplex
PubMed: 35108731
DOI: 10.1055/s-0041-1740218 -
Clinical Neurology and Neurosurgery Dec 2022The global increase in the "ultra-geriatric" population (aged 80 years and older) has led to higher demand for neurosurgical procedures in this vulnerable population.... (Review)
Review
OBJECTIVE
The global increase in the "ultra-geriatric" population (aged 80 years and older) has led to higher demand for neurosurgical procedures in this vulnerable population. The objective was to evaluate the safety and efficacy of advanced microsurgical procedures on ultra-geriatric patients, in our modern era of neurosurgery, anesthesiology, and advanced medical care.
METHODS
The study examined 66 complex cranial procedures, performed on 65 ultra-geriatric patients, who constituted 3.8% of the 4461 consecutive neurosurgical procedures performed by a single neurosurgeon over 14-years in a tertiary care university hospital. Excluded from this study were intra- or extra-axial spontaneous hematomas or traumatic brain injuries, infections, biopsy-only cases and carotid endarterectomies.
RESULTS
The most common indication for surgery for the 66 complex cranial procedures were meningiomas (23.9%), followed by gliomas (17.9%), and metastatic brain tumors (17.9%). Postoperative complications occurred in seven procedures (10.60%). No patient deaths were directly caused by intra- or postoperative events, and only one 30-day mortality occurred. All deceased patients had a statistically significant higher American Society of Anesthesiologists (ASA) class (p = 0.024). However, there was no significant correlation between ASA class and modified Rankin scale at discharge (p = 0.238).
CONCLUSION
With the aging global population and increasing life expectancy, the number of ultra-geriatric patients with complex pathologies seeking advanced microsurgical treatment is growing. Therefore, neurosurgeons are confronting a growing number and variety of complex pathologies in ultra-geriatric patients in their daily practice. Regardless of advanced age, microsurgery provides safe and effective treatment, with age alone not being a barrier to proper neurosurgical treatment when other risk factors are adequately modified.
Topics: Aged; Humans; Microsurgery; Neurosurgical Procedures; Neurosurgery; Meningioma; Postoperative Complications; Meningeal Neoplasms
PubMed: 36332417
DOI: 10.1016/j.clineuro.2022.107500 -
Turkish Neurosurgery 2018Although endoscopic techniques have many advantages including improved visualization and magnification, they are also associated with limitations. The objective of this... (Review)
Review
Although endoscopic techniques have many advantages including improved visualization and magnification, they are also associated with limitations. The objective of this review is to discuss the practical aspects that can reduce complications after endoscopic procedures, and their management. The review is based on the personal experience of more than 2000 neuroendoscopic procedures performed by the senior author. Topic search was made on PubMed using Neuroendoscopy, complications and neuroendoscopy, complication avoidance and neuroendoscopy, endoscopic neurosurgery, and minimally invasive neurosurgery. Relevant articles were selected after analyzing abstracts and/or topics. Endoscopic procedures are also associated with limitations such as obstruction in instruments manipulation, steep learning curve, blind area, difficulty in visualization, disorientation, loss of stereoscopic image and others. Neuroendoscopy is distinct from microsurgery and the surgeon has to learn endoscopic skills in addition to microsurgical techniques. Difficulties in controlling bleeding, working in a limited area, higher complication rate during the initial learning curve and longer operative time are some of the limitations. Attending live workshops, practicing on models, and hands on cadaveric workshops can reduce the learning curve. Proper case selection, multidisciplinary team approach, watching operative video, visiting other departments, observing a skillful endoscopic surgeon, lab training, and simulators can improve results and shorten the learning curve. Limitations of this review are that the search is limited to the English literature and personal experience of a single surgeon that may create some bias. Although neuroendoscopic techniques are associated with improved results in some indications, they have many limitations. Neuroendoscopic skills need to be learned to improve results.
Topics: Humans; Microsurgery; Neuroendoscopy
PubMed: 27943227
DOI: 10.5137/1019-5149.JTN.18923-16.1 -
World Neurosurgery Aug 2016
Topics: Clinical Laboratory Techniques; History, 20th Century; History, 21st Century; Humans; Microsurgery; Neurosurgery; United States
PubMed: 27318311
DOI: 10.1016/j.wneu.2016.06.035 -
Journal of Plastic, Reconstructive &... Oct 2023Microsurgery is most commonly used in the anastomosis of vessels, flap harvesting, lymphedema, and nerve reconstruction, among others. During the 1920s the first... (Review)
Review
BACKGROUND
Microsurgery is most commonly used in the anastomosis of vessels, flap harvesting, lymphedema, and nerve reconstruction, among others. During the 1920s the first microscope was invented by Nylen and Holmgren, quickly becoming the gold standard for microsurgery. However, technological advances have come forth in the form of exoscopes.
METHODS
A search for full-text articles where using an exoscope was compared with a traditional operating microscope was conducted on the databases PubMed, Scopus, Web of Science, and Embase. The following terms were used to guide our search: Microscope AND exoscope AND plastic surgery; Microscope AND exoscope AND microvascular surgery.
RESULTS
Our search yielded 69 studies, of which 12 were included. Five exoscope systems were used by the authors. All studies reported the exoscope as a valid alternative to the standard operating microscope. The exoscope was reported as non-inferior to the operating microscope. Although some studies reported lower quality of image, this did not seem to influence the outcome of surgeries. Newer models may have bridged the gap between the operating microscope's image quality and the exoscope. Superior ergonomics was always reported among the included studies.
CONCLUSION
Based on our search, we conclude that the exoscope is a safe and valid alternative to the operating microscope in plastic surgery. As newer models are now commercially available, these have overcome difficulties in image quality and zoom capabilities, responsible for the main drawbacks of the first exoscope systems.
Topics: Humans; Surgery, Plastic; Microscopy; Neurosurgical Procedures; Plastic Surgery Procedures; Microsurgery
PubMed: 37549541
DOI: 10.1016/j.bjps.2023.07.028 -
Journal of Plastic, Reconstructive &... Nov 2022Microsurgery is a technically demanding aspect of surgery that is integral to a variety of sub-specialties. Microsurgery is required in high-risk cases where time is... (Review)
Review
BACKGROUND
Microsurgery is a technically demanding aspect of surgery that is integral to a variety of sub-specialties. Microsurgery is required in high-risk cases where time is limited and pressure is high, so there is increasing demand for skills acquisition beforehand. The aim of this review was to analyse the available literature on validated microsurgical assessment tools.
METHODS
Covidence was used to screen papers for inclusion. Keywords included 'microsurgery', 'simulation', 'end-product assessment' and 'competence'. Inclusion criteria specified simulation models which demonstrate training and assessment of skill acquisition simultaneously. Tools which were used for training independently of technical assessment were excluded and so were tools which did not include a microvascular anastomosis. Each assessment tool was evaluated for validity, bias, complexity and fidelity and reliability using PRISMA and SWiM guidelines.
RESULTS
Thirteen distinct tools were validated for use in microsurgical assessment. These can be divided into overall assessment and end-product assessment. Ten tools assessed the 'journey' of the operation, and three tools were specifically end-product assessments. All tools achieved construct validity. Criterion validity was only assessed for the UWOMSA and GRS. Interrater reliability was demonstrated for each tool except the ISSLA and SAMS. Four of the tools addressed demonstrate predictive validity. CONCLUSION: Thirteen assessment tools achieve variable validity for use in microsurgery. Interrater reliability is demonstrated for 11 of the 13 tools. The GRS and UWOMSA achieve intrarater reliability. The End Product Intimal Assessment tool and the Imperial College of Surgical Assessment device were valid tools for objective assessment of microsurgical skill.
Topics: Humans; Clinical Competence; Reproducibility of Results; Microsurgery; Anastomosis, Surgical; Computer Simulation
PubMed: 36151038
DOI: 10.1016/j.bjps.2022.06.092 -
World Neurosurgery Jan 2022Side-to-side anastomosis is the most challenging anastomosis owing to the difficult intraluminal suturing technique, which requires practice in the microsurgical...
BACKGROUND
Side-to-side anastomosis is the most challenging anastomosis owing to the difficult intraluminal suturing technique, which requires practice in the microsurgical laboratory before application in patients in the operating room. The objective of this study was to describe 2 side-to-side microvascular anastomosis training models using rat cervical vessels.
METHODS
Two side-to-side microvascular anastomosis training models, one with rat cervical vessels between bilateral common carotid arteries (CCAs) (CCA-CCA anastomosis) and one with a unilateral CCA and the anterior facial vein of the external jugular vein (EJV) (CCA-EJV anastomosis), were studied. Diameters of CCA and anterior facial vein, distances between temporary clips and length of arteriotomies, and vascular clipping time were recorded. Patency rates were evaluated immediately and 7 days after the procedure.
RESULTS
Diameters of CCA and anterior facial vein were 1.00-1.20 mm and 1.40-1.80 mm, respectively. A segment of vessel slightly longer than the arteriotomy or venotomy was temporarily clipped; mean lengths between temporary clips in CCA-CCA anastomosis and CCA-EJV anastomosis of 6.48 ± 0.66 mm and 8.02 ± 0.45 mm, respectively, were used in the study. The minimum distance between the corner of the arteriotomy or venotomy and the clip was 1 mm. The mean vascular temporary clipping times in CCA-CCA anastomosis and CCA-EJV anastomosis were 40.05 ± 3.92 minutes and 42.50 ± 4.82 minutes, respectively. Patency rates of 100% were achieved in all anastomoses.
CONCLUSIONS
CCA-CCA and CCA-EJV side-to-side anastomosis models using rat cervical vessels are feasible and effective side-to-side anastomosis training models.
Topics: Anastomosis, Surgical; Animals; Carotid Artery, Common; Cervical Vertebrae; Humans; Jugular Veins; Male; Microsurgery; Rats; Rats, Sprague-Dawley; Vascular Surgical Procedures
PubMed: 34626847
DOI: 10.1016/j.wneu.2021.09.133 -
Annals of the Royal College of Surgeons... May 2022
Topics: Anastomosis, Surgical; Humans; Microsurgery
PubMed: 34730402
DOI: 10.1308/rcsann.2021.0214 -
Therapeutische Umschau. Revue... 2016Cataract surgery has tremendously evolved in recent years. Innovations include micro-incision cataract surgery through incisions smaller than 2mm, high-fluidics... (Review)
Review
Cataract surgery has tremendously evolved in recent years. Innovations include micro-incision cataract surgery through incisions smaller than 2mm, high-fluidics phacoaspiration and laser phacoemulsification to minimize or replace the use of ultrasound, the advent of femtolasers for high-precision incisions in the cornea, the lens capsule and the cataractous lens, aspheric intraocular lenses (IOLs) to enhance the quality and contrast of the image, multifocal and enhanced-depth-of-focus IOLs to correct presbyopia, advancements in biometry and IOL power calculation, prevention of secondary capsule opacification by improvements in the design and material of the IOLs and surgical techniques like capsule polishing and posterior capsulorhexis, and pharmacological prophylaxis and possible future treatment of the cataract itself. Finally, cost-effectiveness and future potential of same-session bilateral cataract surgery are discussed.
Topics: Cataract; Cataract Extraction; Humans; Lens Implantation, Intraocular; Lenses, Intraocular; Microsurgery; Minimally Invasive Surgical Procedures; Surgery, Computer-Assisted
PubMed: 26982642
DOI: 10.1024/0040-5930/a000756 -
Journal of Reconstructive Microsurgery Jan 2018Compared with hand-sewn anastomoses, microvascular anastomotic coupling devices (MACDs) provide equivalent flap survival and reduced operative time. To date, an... (Comparative Study)
Comparative Study Review
BACKGROUND
Compared with hand-sewn anastomoses, microvascular anastomotic coupling devices (MACDs) provide equivalent flap survival and reduced operative time. To date, an economic analysis of MACDs has not been reported. The objective of this study was to evaluate the economics of a venous anastomosis performed using a coupling device compared with a hand-sewn anastomosis.
METHODS
Economics were modeled for a single free tissue transfer (FTT) requiring one venous anastomosis performed with either hand-sewn sutures or with a coupler-assisted anastomosis using the GEM COUPLER. Fixed and variable costs incurred with each anastomotic technique were identified with an activity-based cost analysis. Price lists were retrieved from suppliers to quantify disposable costs and capital expenditures. Two literature reviews were executed to identify microsurgical operating room (OR) costs and operating time reductions with coupler-assisted anastomoses.
RESULTS
For each venous anastomosis, the use of the anastomotic coupler increased disposable costs by $284.40 compared with a hand-sutured anastomosis. Total fixed and variable OR costs were $30.82 per minute. Operating time was reduced by a mean of 16.9 minutes with a coupler-assisted anastomosis, decreasing OR costs by $519.29. Total savings of $234.89 were generated for each coupler-assisted anastomosis, recuperating the device's capital expenditure after 13 uses.
CONCLUSION
Compared with a hand-sewn venous anastomosis, an MACD produces savings with each case and quickly recoups the device's capital expenditure. Despite its limitations and simplicity, this study provides a practical economic analysis that can help inform purchasing decisions, particularly for smaller volume centers where the economic rationale may be less clear.
Topics: Anastomosis, Surgical; Cost-Benefit Analysis; Free Tissue Flaps; Humans; Microsurgery; Suture Techniques
PubMed: 28946154
DOI: 10.1055/s-0037-1606540