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PubMed1981

[Teaching of microsurgery].

Referring to his personal experience, the author points out the possibilities of applying microsurgery, which confers an autonomous dignity to this medical branch. Therefore, it is to hope that a didactic and specialistic recognition of microsurgery will determine the formation of specifically trained teams. Lastly, the versatility of microsurgery as applied to modern biliary ducts surgery has been underlined, both for derivative and reparative interventions.

Animals↗

PubMedDate not supplied

Microsurgery in urology.

Microsurgery is becoming increasingly widely accepted in the field of urology, and microsurgical training well become an integral part of the programs for Residents in University Schools of Urology. In this paper we outline the present clinical application of microsurgery in urology and perspectives, for example: workbench surgery, testis transplantation, vasovasostomy, revascularization for impotence, penis replantation, microsurgery of the urinary tract.

Epididymis↗

PubMed1982

Cryosurgery or microsurgery in the management of acromegaly.

Fifty-six patients with growth hormone-secreting pituitary adenomas, 28 treated by cryoablation and 28 by microsurgery, have been followed up from three to eight years. Mean serum growth hormone concentrations were less than 10 mU/L in 19 patients (68%) after microsurgery as compared with seven (25%) after cryosurgery. Hypopituitarism and operative complications were more frequent after cryosurgery. Transsphenoidal microsurgery was particularly successful in reducing growth hormone secretion without impairing normal pituitary function, when the patient had not been previously treated by another method.

Acromegaly↗

PubMedDate not supplied

[Microsurgery in 1982. Importance of the technique in the different surgical specialties and training possibilities (author's transl)].

Recently microsurgical techniques have become standard procedures in microvascular surgery especially in plastic surgery and hand surgery and peripheral nerve surgery. In gynecology and urology microsurgery has improved the results of infertility surgery by two or three times. Microsurgical training in vascular and nerve repair should be undertaken by every fellow in plastic and reconstructive surgery of handsurgery. Gynecologists and urologists should be aware of the possibilities of microsurgery and have the opportunity during their training to participate on these procedures. They should however not need to have full knowledge of the technical details and refer patients to specialized infertility microsurgery centers.

Education, Medical, Continuing↗

PubMed1982

Microsurgery for tubal and ovarian disease.

The use of microsurgery has been responsible for improvements of various aspects of the management of tubal and ovarian disease. Microsurgery has not merely been a vital experimental tool in the study of tubal physiology and pathology, but has been of proven value in alleviating infertility following pelvic inflammatory disease and for reversal of sterilization. The most dramatic advance has been in the treatment of cornual damage but microsurgery also has a place for salpingostomy and for the preparation of the pelvis before attempts are made at egg recovery for in vitro fertilization.

Animals↗

PubMed1980

Microsurgery in Japan.

Since the early 1960s microsurgery has been practiced by some of the pioneers in this country, and in the past decade it has given rise to a new era in the fields of reconstructive orthopedic surgery and plastic surgery, enabling repair of blood vessels and nerves, replantation of limbs and digits, and transfers of several composite tissues. A number of experiments and much clinical research in this field has been carried out by many Japanese microsurgeons, who contributed significantly to the development of microsurgery in the world. I have reviewed the history and the progress of microsurgery in Japan by introducing the important and interesting reports on this subject in chronologic order.

Animals↗

PubMed1981

[Microsurgery].

Generally microsurgical techniques were successful. They opened a new development in plastic and reconstructive surgery. An inroad on other departments is now on process. Moreover indications for use of microsurgical technics grew wider. So tendon-transplantations and other such manipulations will be carried out with microsurgery's help. For us training in microsurgery technics is an obligatory instruction for plastic surgery. Only in that way a surgeon standing in education will learn to understand all possibilities of microsurgery. This means a benefit for every surgeon even if he will not have to do microsurgical operations by himself in the remote future.

Adult↗

PubMed1981

[Microsurgery applied to surgery of Vater's ampulla].

Microsurgery, applied to surgery of Vater's papilla, does not represent a new development in surgical technique, but rather propounds the possibility of a new view of infundibular papilla which is of great diagnostic value of biliar disease. We see it as being indicated in all those cases in which surgery of papilla is undertaken. In papilla microsurgery technique exists a first period of diagnosis in which a study is made of the infundibula mucous membrane, allowing one to ascertain the state of the wall and possible affectation of the distal parts of the choledochus and of Wirsung ducts. In the second period, or the strictly surgical, microsurgery constantly achieves control of the papilla and its elements, at the same time being antitraumatic and more objective.

Ampulla of Vater↗

PubMed1980

[Prophylaxis of operative macular complications of retinal detachment by microsurgery (author's transl)].

Certain macular lesions which impair the visual results of successful retinal detachment surgery result from the treatment itself. The causes of the macular lesions due to surgery are reviewed. The incidence of those lesions is likely to be decreased by microsurgery which allows for a well controlled surgery. In a series of 100 consecutive retinal detachments successfully operated on by microsurgery--out of 111 consecutive cases operated on--visual acuity of 5/10 or Better was achieved in 45% of the cases, and reading acuity of Parinaud 3 or Better was achieved in 70% of the cases. Neither macular pigment migration nor macular hemorrhage were observed in this series. Nevertheless the incidence of macular pucker due to surgery is 2% and the incidence of cystoid macular edema is 3%. As the incidence of the latter complications is lower in this series than in a previous series the authors believe that the frequency of the macular complications of retinal detachment surgery should be even lower in future with a wider experience of microsurgery.

Cryosurgery↗

PubMed1978

[Progress in the treatment of tubal sterility: microsurgery (author's transl)].

During the last few years microsurgery has evoked general enthusiasm in several surgical specialities and especially in plastic surgery. This is also true of gynaecology, where it is used for the surgery of sterility. Tubal microsurgery improves the results of operations by ensuring that the anatomical reconstruction shall be more precise and by lessening the amount of adhesions and secondary fibrosis. The first results that have been published prove this. The superiority of these difficult techniques is especially demonstrated by tubal recanalisations effected after sterilisation when the anastomosis is made in healthy tissue, being from the isthmus to the isthmus or from the isthmus to the uterus. Microsurgery is also the sole hope for the surgery of tubes that are at present inoperable. It will effect transplantation of the tube as soon as the problem of rejection has been solved.

Fallopian Tubes↗

PubMed1993

Microsurgery alone or with INTERCEED Absorbable Adhesion Barrier for pelvic sidewall adhesion re-formation. The INTERCEED (TC7) Adhesion Barrier Study Group II.

Adhesion re-formation after a reproductive operation, particularly involving the pelvic sidewall, is a prominent cause of failure in the surgical treatment of infertility. This study was done to evaluate the impact of standard microsurgery through laparotomy and the additional benefit of an oxidized regenerated cellulose adhesion barrier (INTERCEED [TC7] Absorbable Adhesion Barrier [Ethicon Inc.]), in reducing pelvic sidewall adhesion re-formation. One hundred and thirty-four patients with bilateral pelvic sidewall adhesions undergoing adhesiolysis by standard microsurgical techniques through laparotomy were treated during a prospective randomized trial involving 13 centers. After adhesiolysis, the deperitonealized surface of one pelvic sidewall was randomly assigned to be covered with INTERCEED Barrier, the contralateral sidewall serving as control. A second-look laparoscopy was performed ten days to 14 weeks postoperatively. Microsurgical adhesiolysis alone resulted in 24 percent of the sidewalls becoming free of adhesions and a 55.6 percent reduction in the area of adherent peritoneum. With microsurgery alone, 60 and 39 percent of adhesions initially characterized as filmy or severe, respectively, were not seen at second-look laparoscopy. The use of INTERCEED Barrier increased the incidence of adhesion-free sidewalls twofold. The treatment was also associated with a statistically significant reduction in the area of peritoneum affected by adhesion re-formation, compared with the control wall. Of the adhesions originally graded as severe, 61 percent of those treated with INTERCEED Barrier did not re-form at all. When evaluated on filmy adhesions, the use of the barrier was associated with a 72 percent reduction in adhesion re-formation. A measurable reduction in adhesion re-formation was found, depending on the initial adhesion type, with microsurgery alone. The addition of INTERCEED Barrier further reduced the incidence, extent and severity of postoperative adhesion re-formation. In this study, 90 percent of the patients benefited from the use of INTERCEED Barrier.

Cellulose, Oxidized↗

PubMed1996

[Newly developed vacuum suction valve for microsurgery].

A vacuum operated suction appliance can be invaluable for all areas of surgery. The suction process carries a greater risk (e.g. dizziness, deafness), especially in microsurgery of the ear. A newly developed vacuum valve for microsurgery that is mechanically adjustable is presented. The surgeon operates the valve with his foot outside the aseptic area of surgery. The valve enables him to regulate the vacuum or to quickly interrupt the suction process. This allows for swifter, safer surgery. Examples of use of the device in microsurgery of the ear are described in detail.

Ear Diseases↗

PubMed1998

[Transanal endoscopic microsurgery--experiences at the Zurich University Hospital].

The advantages of TEM (transanal endoscoic microsurgery) are minimally invasive, exact and full thickness excision of tumors in the rectum and a very low morbidity with excellent comfort for the patient. In a retrospective study all transanal endoscopic operations at Zurich University hospital in the last 5 years have been analyzed (n = 18). 11 adenomas and 5 carcinomas of the rectum have been resected with TEM (one mucosectomy, 16 full wall resections and one segmental resection of the rectum). In the group of the carcinomas there were four preoperatively known carcinomas, one T1 carcinoma was discovered postoperatively in the analyzed tissue. Among the four known carcinomas was one T1 carcinoma, two T2 carcinomas (one of them was thought to be a T1 preoperatively) and one T3 carcinoma. One patient with T2 carcinoma wanted specifically a minimally invasive procedure, the other one with T2 carcinoma was an older patient who didn't qualify for laparotomy. The patient with T3 carcinoma also had a malignant lymphoma. The operation was tolerated well by all the patients. There was one case of peritoneal perforation treated laparscopically and one case of postoperative bleeding. An incontinence of gas in one patient disappeared after 3 months. There was no adjuvant treatment in the group of the T1 carcinomas. One patient with a postoperative T2 carcinoma did not want a chemotherapy. The other two patients with T2 and T3 were polymorbid. Among the resected adenomas there was no case of recurrence. One T2 carcinoma recurred. These results show that transanal endoscopic microsurgery (TEM) is an excellent technique to treat ademomas and T1 carcinomas of the rectum with the advantages of full thickness excision under good vision, a minimal rate of recurrence and maximal patient comfort. The indications for transanal microsurgery are rare. The techically demanding operation is not always simple and should be performed in larger centers only.

Adenoma↗

PubMedDate not supplied

[Postoperative choroid detachment following microsurgery for rhegmatogenous retinal detachment].

PURPOSE: To evaluate the incidence, predisposing and prognosis factors of post-operative choroidal detachment after microsurgery of rhegmatogenous retinal detachment. MATERIALS AND METHODS: We conducted a retrospective study on a series of 595 consecutive rhegmatogenous retinal detachments referred before any previous failed surgery. Univariate statistical analysis of the data was conducted with evaluation of the odds ratio. RESULTS: Postoperative choroidal detachment developed in 23/595 eyes (3.8%). Significant predictive factors for post operative choroidal detachment included patient's age over 50 years, male gender, pseudophakia, retinal detachment higher than 90 degrees and giant tears. We found no correlation between postoperative choroidal detachment and the retinopexy method, subretinal fluid release and the type of scleral buckling procedure (segmental versus incercling). Postoperative choroidal detachment did not influence at a statistically significant level the postoperative outcome. Permanent retinal reattachment was achieved in 20 of the 23 eyes (87%) with postoperative choroidal detachment, and 564 of 572 eyes (93%) with no post-operative choroidal detachment (p > 0.05). Postoperative PVR occurred in 3 of the 23 eyes (13%) with postoperative choroidal detachment and 3 of the 572 eyes (5%) with no postoperative choroidal detachment (p > 0.05). The postoperative visual outcome was not influenced by the occurrence of postoperative choroidal detachment. CONCLUSION: Postoperative choroidal detachment after retinal detachment microsurgery is a rare complication. Its prognosis is good. The occurrence of postoperative choroidal detachment does not influence the postoperative outcome of retinal detachment microsurgery.

Adult↗

PubMed1986

Personal computer-controlled microsurgery of fertilized eggs and early embryos.

The microsurgery of mouse and rat eggs and early embryos was attempted using a micromanipulator driven by three pulse motors. The pulse signals that regulate the three pulse motors for the X, Y, and Z axes were controlled according to the personal computer programs produced on the basis of the displayed data. As a result, the following was found. 1) The computer-controlled operation was possible in the X and Y plane on a specimen previously suctioned and retained by a holding pipet. A microinjection pipet was inserted into the male pronucleus of a fertilized egg and the morula was bisected using a microblade; these microtools were moved horizontally. 2) A more complicated micromanipulation in two dimensions (X and Z axes), which is very difficult manually, was possible by using this system. 3) microsurgery (microinjection of a fluorescent material (FITC) into the male pronucleus, enucleation of a fertilized egg, and vertical or horizontal bisection of morulae) was carried out successfully by a student who had no practical experience in this field. These facts suggest that the system markedly facilitates microsurgery, without need for full training in the manual procedures.

Journal Article↗

PubMed2002

Transanal endoscopic microsurgery: the first 50 cases.

BACKGROUND: Transanal endoscopic microsurgery is a form of minimally invasive rectal surgery first used at Cabrini Hospital in April 1997. This paper presents a prospective analysis of the first 50 cases with a median follow up of 33 months (range 20-48 months). METHODS: Prospective data was obtained from all cases between April 1997 and June 2000. RESULTS: Forty-nine patients (30 men and 19 women) underwent 50 procedures. Thirty-six had benign lesions and 14 malignant. The mean distance of the lower edge of the lesion from the anal verge was 8.7 cm. Three cases were converted to traditional transanal or transabdominal operations. Full-thickness excision was performed on 26 patients and the rectal wound was closed in 13 cases. The mean duration of transanal endoscopic microsurgery was 67 min (range 20-175), with a mean blood loss of 24 mL (0-300). The mean diameter and area of the fixed specimen was 3.7 cm (1.5-9.8) and 11.4 cm2 (0.8-18.9), respectively. Complications included postoperative fever (3), urinary retention (1) and per rectum bleeding (1). There was one death. The mean length of stay was 4 days. Histology confirmed complete excision in 39 (78%) cases and there have been two instances of local recurrence of adenoma (5%). CONCLUSIONS: Transanal endoscopic microsurgery is an effective, safe and cost-beneficial procedure for local excision of selected lesions in the middle and upper thirds of the rectum.

Aged↗

PubMed1975

Stroboscopic microsurgery of the larynx.

An attempt was made to develop a new method of microsurgery of the larynx. A newly designed laryngostroboscope suitable for our purpose was employed in our new method. The vibratory pattern was stroboscopically examined through the operating microscope throughout the operative procedure while the patients who were able to phonate due to neuroleptanalgesia were asked to do so. Thus, the determination of the completion time of the operation was obtained mainly by the observation of stroboscopic vibratory patterns of the vocal cords. Since the beginning of 1972, this stroboscopic microsurgery of the larynx has been satisfactorily employed in more than 200 cases of various kinds of laryngeal lesions. As a result, a remarkable improvement of the postoperative voice was observed by phonatory examinations as well as by audible estimation.

Adult↗

PubMed1998

Transanal endoscopic microsurgery: a single surgeon's experience.

OBJECTIVE: To evaluate a single surgeon's experience with transanal endoscopic microsurgery (TEM) with regard to incidence of complications, recurrence rate of benign and malignant lesions, and impact on the treatment of rectal cancer. DESIGN: Prospective tumor registry. SETTING: Tertiary care university hospital. PATIENTS: Seventy-three patients undergoing TEM between January 1991 and November 1996. MAIN OUTCOME MEASURES: Complications, recurrence rates, and use of this technique with respect to radical operations. RESULTS: The arrival of TEM was associated with an increase in the number of operations for rectal cancer; however, the use of TEM remained constant relative to radical resections. Use of TEM resection alone is appropriate for all adenomas and cancers staged Tis and T1. Use of TEM alone is not an appropriate treatment for T2 cancers. Four patients (5%) experienced fecal soilage, which was long lasting in only 1 (1%). CONCLUSIONS: Transanal endoscopic microsurgery is a safe technique and provides improved access to lesions in the middle and upper rectum. Thus far, it has not had a significant impact in the overall treatment of rectal cancer.

Adenoma↗