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Clinical Performance of Digital Microscopes in Microsurgery: A Retrospective Analysis of Operative Time and
Tomoyuki Ito1, Yuichi Ichikawa1,2, Yukio Seki1
1Department of Plastic and Reconstructive Surgery, Juntendo University School of Medicine, Tokyo, Japan.
Background:
Digital microscopes (DMs) have been increasingly adopted in microsurgery; however, clinical evidence regarding their operative efficiency, safety, and learning curve compared with conventional optical microscopes (OMs) remains limited. In particular, anastomosis-specific operative time and intraoperative thrombosis-an indicator closely related to technical precision-have not been sufficiently evaluated in clinical settings. Therefore, this study aimed to evaluate the learning curve associated with digital microscope adoption in microsurgical reconstruction using operative time metrics and to assess thrombotic events as exploratory safety outcomes.
Methods:
We retrospectively reviewed 123 consecutive free-flap reconstructions performed by three experienced plastic surgeons between June 2022 and March 2025. The cases were categorized into three groups: OM, early-phase DM (DM-T1), and late-phase DM (DM-T2). The choice of visualization system was determined by operating room availability rather than surgeon preference. Microscope usage time, arterial and venous anastomosis times, and intraoperative and postoperative arterial or venous thromboses were analyzed. Intraoperative arterial patency was assessed by palpation and pinprick tests, and venous patency was assessed by the patency test. Learning curve effects were evaluated by comparing DM-T1 and DM-T2.
Results:
The number of cases in each group was 37, 34, and 52 in the DM-T1, DM-T2, and OM groups, respectively. Mean microscope usage time was longer in DM-T1 than in DM-T2 and OM (71.9 ± 15.0 vs. 57.6 ± 13.4 vs. 58.5 ± 19.8 min; p = 0.0055 and p = 0.0021). Mean arterial anastomosis time was also longer in DM-T1 compared with DM-T2 and OM (22.5 ± 7.2 vs. 19.0 ± 5.1 vs. 17.4 ± 4.9 min; p = 0.048 and p = 0.0028). Venous anastomosis time showed a decreasing trend from DM-T1 to DM-T2 but did not reach statistical significance. The incidence of intraoperative and postoperative thrombosis did not differ among groups (intraoperative arterial thrombosis: 18.9%, 14.7%, and 15.4% in the DM-T1, DM-T2, and OM groups, respectively; p ≥ 0.05).
Conclusion:
DM demonstrates a measurable learning curve, with operative efficiency improving to levels comparable to those of OM, while maintaining similar thrombotic safety. DMs are a reliable visualization platform for microsurgical reconstruction.
Insights
Digital microscopes (DMs) show a learning curve in microsurgery, with operative efficiency improving over time. DMs offer comparable safety to optical microscopes (OMs) for microsurgical reconstruction.
Area of Science:
- Microsurgery
- Plastic Surgery
- Surgical Technology
Background:
- Limited clinical data exists on the operative efficiency and safety of digital microscopes (DMs) compared to optical microscopes (OMs) in microsurgery.
- Key metrics like anastomosis time and intraoperative thrombosis require further evaluation in clinical settings.
Purpose of the Study:
- To evaluate the learning curve of digital microscopes (DMs) in microsurgical reconstruction using operative time.
- To assess thrombotic events as a safety outcome associated with DM use.
Main Methods:
- Retrospective review of 123 free-flap reconstructions.
- Cases categorized into optical microscope (OM), early-phase digital microscope (DM-T1), and late-phase digital microscope (DM-T2) groups.
- Analysis of microscope usage time, anastomosis times, and thrombotic events; learning curve assessed by comparing DM-T1 and DM-T2.
Main Results:
- Mean microscope usage and arterial anastomosis times were significantly longer in DM-T1 compared to DM-T2 and OM.
- Venous anastomosis time showed a decreasing trend from DM-T1 to DM-T2.
- No significant difference in intraoperative or postoperative thrombosis incidence was observed among the groups.
Conclusions:
- Digital microscopes (DMs) exhibit a learning curve, with operative efficiency improving to levels comparable to optical microscopes (OMs).
- DMs maintain similar thrombotic safety profiles to OMs.
- DMs are a reliable visualization platform for microsurgical reconstruction.