Microsurgery means that surgeons use fine microsurgical instruments and suture materials to perform fine surgery on small tissues with the help of the magnification of the operating microscope.
Microsurgery technology is a specializedSurgeryTechnology has been widely used in various disciplines of surgery.
Surgical characteristics
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When operating under the operating microscope, the tissue is magnified, which can not only see the small tissue that cannot be seen by the naked eye in the operating field, but also have a stereoscopic sense, thus facilitating surgeons to accurately dissect, cut and suture various tissues.However, even surgeons who are experienced in suturing blood vessels with naked eyes, if they do not receive special training, are still not used to microsurgery at the beginning. They often have hand eye disharmony, which affects the operation under the microscope. Therefore, it takes a period of training and adaptation to skillfully perform surgery under the operating microscope.Features of microsurgery: ① Due to the small field of vision of the microscope,Surgical instrumentsandNeedleworkOften out of sight and difficult to find; ②Due to the limited depth of field, the surgical field is blurred when moving up and down slightly; ③The shaking that cannot be seen by the naked eye is significant under the microscope, so the slight shaking will affect the operation; ④Because the eye muscles have an adjustment process for different focal lengths, the eyes can not see the fine structure immediately after leaving the eyepiece and returning.
Technical training requirements
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According to the characteristics of the operation under the operating microscope, the following requirements should be followed during the microsurgical technical training:
1. The operating microscope should be placed properly first, and the distance between the eyepiece and the operator's pupil should be adjusted to eliminate double vision, so that the image of the operating field is clear and three-dimensional.
2. The movement of the training hand should be gentle, steady, and small, to avoid shaking beyond the field of vision.It is required to have an accurate sense of the tissue position seen under the microscope, and be able to quickly reach the surgical site within the field of vision.
3. The training of cutting, sewing, knotting and thread trimming can be carried out on the same plane to avoid moving up and downBlurred visionPhenomenon.It is also required to be able to adapt to various magnification and depth of field during operation.
4. Train to lean the forearm on the operating table, and use the instrument through the coordinated action of thumb, index finger and wrist.
5. Train the eyes not to leave the eyepiece, practice basic operations such as incision, separation, suture and knotting under the eyepiece, and train to be able to quickly locate and master the use of various instruments.Keep the eye on the eyepiece and change the instrument with both hands.
6. When training the eye to leave and return to the eyepiece, the eye muscle has rapid adjustment ability.
7. The cooperation between the trainer and the assistant, both of whom should be trained in microsurgery technology, understand the characteristics of microsurgery, understand the whole process of surgery, and be familiar with the sequence and methods of surgery.
8. The training of microsurgery technology shall be highly minimally invasive, highly precise and highly accurate.
Basic technology
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The basic techniques of microsurgery are different from those of general surgery.Surgeons must have a process of adaptation and retraining in basic microsurgical techniques when performing microsurgical canalicular anastomosis.
1. Microdissection and separation technology In order to make tissue incision less damaged and accurate, the ll blade or 15 blade is generally used, so that the incision technology is like micro engraving technology.The microstructure separation is mainly sharp separation, which is separated with a pointed blade or sharp scissors.
2. Micro tissue lifting technology uses pointed, toothless micro tweezers to lift tissue.When anastomosing small tubes in microsurgery, only forceps should be used to hold the outer membrane of small tubes to avoid damaging the inner membrane.
3. The microstructural traction exposure technology The surgical field was exposed by hand surgical small retractor;The stretch of blood vessels and nerves is usually carried out with thin rubber sheets.When anastomosing blood vessels, small automatic spreaders are often used to expose the surgical field.
4. Ligation, hemostasis and hemostasis in microsurgeryBipolar coagulator。The hemostasis of the branches of the anastomosed vessels was mainly ligation.
5. The debridement technology of microsurgery requires that the necrotic tissue should be eliminated as far as possible, and the vascular bed and nerve bed with good blood supply should be created.The use of non-invasive cleaning can reduce infection.
Hand and foot plastic surgery has been widely carried out microsurgery for many years, and the operations completed include orthopaedic categories such as muscle, bone, joint, etc.Looking forward to the future, microsurgery will develop in an all-round way in the 21st century. The application of microsurgery technology to experimental surgery, fetal surgery and close integration with technology will transform the whole medicine.Therefore, it is no exaggeration to say that microsurgery will be the main theme of medicine in the 21st century.
