Intraluminal endoscopic evaluation of microvascular anastomosis

Microsurgery is an established technique in different surgical disciplines. Training in the laboratory remains the mainstay for delivering optimal performance in the operating room. Routine evaluation of microsurgical anastomosis during training usually consists of longitudinal splitting of the performed anastomosis. We present our initial experiences with endoluminal evaluation of microvascular anastomosis by endoscopy. In all experimental settings flexible miniature endoscopes with diameters of 1 and 2mm were used. All experiments were conducted in porcine coronary arteries or artificial vessels such as silastic tubes. The endoscope was introduced into the vessel lumen via an i.v. cannula. Specialised digital software was developed to enhance the displayed image. This so-called round-scan system delivers a two-dimensional picture of the endoluminal surface of a microvascular anastomosis. With the developed scanning software we were able to overcome technical limitations in microvascular endoscopy. Good results were obtained in 1.7 mm artificial vessels and technical errors in microvascular anastomosis were revealed. Endoluminal microvascular endoscopy offers great potential in evaluating skills in microvascular surgery in training settings but theoretically can also be employed in clinical situations. Main limitations encountered include fluids such as blood within vessels and the slow but steady pace by which the endoscope has to be withdrawn from within the vessel lumen.