Microsurgery

Microsurgery can be defined as surgery on very small body structures, such as blood vessels and nerves, performed with the aid of a microscope and specialized instruments. The purpose of microsurgery is to allow the surgeon a clear and amplified visualization of the operating field. Since its inception into surgical practice in the mid-20th century, microsurgery has rapidly increased in practice and today is used in a wide variety of procedures.

The first reported microsurgery occurred in 1960, when Jules Jacobson used a microscope in the process of repairing blood vessels. In 1964, Harry Bunke performed the first successful replantation, or reattachment, of an amputated body part, when he reattached a rabbit's ear. Another important historical event in microsurgery occurred in 1968 when John Cobbett transplanted a human patient's great toe to the patient's hand where a thumb was missing, in effect transforming a toe into a finger.

Since that time, microsurgery has pervaded many surgical specialties. Neurosurgeons use microsurgery to repair vascular defects such as aneurysms and arteriovenous malformations (AVMs), as well as to remove tumors from the brain and spinal cord. Plastic surgeons use microsurgery in many reconstructive techniques. Ophthalmologists remove cataracts, transplant corneas, and repair retinas with the aid of an operating microscope. General surgeons perform transanal endoscopic microsurgery in the treatment of rectal cancer. Other surgeons utilizing microsurgery include otolaryngologists, urologists, gynecologists, and orthopedists.

The basic techniques in microsurgery include blood vessel repair, nerve repair, vein grafting, and nerve grafting. Blood vessel repair typically involves a procedure called anastomosis, or the connection of two separated blood vessels. Similarly, in nerve repair, two cut ends of a nerve are reconnected, also called nerve anastomosis or neurorrhaphy. Vein grafting is the process of transferring a segment of vein from another part of the body (typically the extremities, where there is an abundance of collateral circulation) to reconnect two ends of a severed vessel that would otherwise be under too much tension if they were reconnected to each other. Nerve grafting is performed for the same reason of tension reduction and often involves transfer of the sural nerve of the leg. These techniques allow for some of the more common procedures in microsurgery, namely replantation, transplantation, and free-tissue transfers. Free-tissue transfers, also known as flaps, are used to reconstruct tissues that are damaged beyond repair.

Since microsurgery requires very specialized equipment, it is not as readily available in poorer nations compared to wealthier counterparts. Therefore, some international health groups are working toward increasing worldwide awareness of the possibilities of microsurgery. For example, one objective of the American International Health Alliance is to familiarize physicians at the global level with microsurgery and other techniques such as laparoscopy and echocardiography. There are also many national and international microsurgery organizations that encourage collaboration and [Page 1126]sharing of knowledge. With continuing efforts such as these, hopefully more physicians and patients will be able to benefit from the advantages of microsurgery.