Enhancing Microvascular Anastomosis Using an Axial-View Microscope.

Area of Science:

• Microsurgery
• Vascular Surgery
• Surgical Instrumentation

Background:

• Conventional digital microscopes offer a limited bird's-eye view, hindering accurate identification of vascular structures like the lumen and tunica intima during microvascular anastomosis.
• This restricted perspective can impede precise surgical maneuvers in delicate vascular procedures.

Purpose of the Study:

• To develop and evaluate a novel axial-view microscope (aMS) system designed to provide an improved visualization of the vascular stump.
• To assess the impact of the aMS on the efficiency and accuracy of microvascular anastomosis compared to a conventional bird's-eye view microscope (bMS).

Main Methods:

• A proprietary digital microscope integrated with the aMS system was utilized.
• Ten chicken femoral arteries underwent anastomosis creation, with procedures performed using either the aMS-assisted method or bMS alone.
• Anastomosis creation was divided into two stages, with operative times meticulously recorded for comparison between the aMS-assisted and bMS-only groups.

Main Results:

• The aMS-assisted group demonstrated a significantly shorter duration for Stage 1 (tunica intima identification and needle insertion), with an average ratio of 0.58 compared to the bMS-only group (p < 0.001).
• Overall anastomosis time was also significantly reduced in the aMS-assisted group, with an average ratio of 0.88 (p < 0.001).

Conclusions:

• The aMS system offers direct visualization of the vascular cross-section, enabling rapid identification of the tunica intima.
• The use of aMS does not prolong other stages of microvascular anastomosis and may enhance the operative view.
• This novel system shows potential for reducing anastomosis time and improving outcomes in microsurgical procedures.