Supermicrosurgical Vascular Anastomosis-A Comparative Study of Lumen-Enhancing Visibility Techniques

Background: The development of microsurgical techniques has enabled reconstructive versatility in various clinical scenarios. Supermicrosurgery is an advanced microsurgical technique ensuring precise reconstructions by operating on small-caliber vessels and nerves, with applications in reconstructive surgeries. Objectives: This study aims to compare the effectiveness of four low-cost training models, thereby improving surgical precision and reducing the learning curve for novice surgeons. Materials and Methods: We conducted a prospective non-randomized study comparing the classic anastomosis technique, the intravascular stenting (IVaS) technique, the color contrast (CC) technique, and our newly introduced double-contrast (DC) technique, which combines IVaS with CC. We used a non-living experimental model represented by chicken wings, analyzing the vessel preparation and anastomosis time, anastomosis patency, and back wall biting through a standardized protocol. We performed 120 end-to-end anastomoses in total, with vessel diameters ranging from 0.5 to 0.8 mm. Results: CC demonstrated superior time efficiency and success rates, reaffirming it as a reliable option in supermicrosurgery, while DC showed slightly better time efficiency and patency compared to both IVaS alone and the classic method. CC outperformed the others in anastomosis time, patency, and back wall catching, reaffirming its reliability in supermicrosurgery. Conclusions: Although DC did not significantly improve patency, it reduced back wall engagement. This makes the DC technique beneficial for trainees working on vessels under 0.5 mm in diameter, where stenting is often required, improving surgical precision and reducing the learning curve, leading to better outcomes in supermicrosurgery.