A series of tutorials on microsurgery, starting from the basics working up to more advanced techniques, uploaded in random order.
All videos: https://www.youtube.com/user/DrWmicrosurgery/videos
Copyright 2012 Victor Volovici (DrW).
Carl Zeiss Opmi Pico Microscope, various colour filters applied, magnification 10x-50x.
The best way to begin in microsurgery is to start by suturing a cut piece of latex glove. We prefer to secure it with 3 or 4 pins to a cork-based support, others prefer to spread it over a box or hollow dome, securing it with tape. We lean towards the first approach as it allows for better hand positioning during the first microsuture manoeuvres, as well as for easier turning of the latex piece in order to evaluate proper technique, as showed at the end of the video.
We then proceed to make a couple of incisions to the glove with a no. 23 scalpel blade, in various directions to simulate various real-life suturing position possibilities. For the first knots one should use the 7-0 USP thread, in order to get accustomed to the feel of the microscope and to the tremor which inevitably befalls those who encounter the microsurgical environment for the first time. The knots are placed evenly spaced, merely approximating the edges of the cut, without strangulation, overlapping or kinks. As a rule of the thumb, if one feels tension in the thread, one has applied too much tension to the anastomosis. One must merely approximate the edges, make them come together, lips slightly touching, in order to achieve satisfactory results. Also, the bite of the distal edge must be the same size as the bite taken from the proximal edge. All these must be the items to focus on during the first hours in the microsurgery laboratory. We then allow trainees to increase magnification, as well as to apply sutures with 8-0 and 9-0 threads, finally reaching the 10-0 thread (plus maximum magnification). After several knots have been placed under these circumstances, proper technique is assessed and we move on to leaf suturing, which is the subject of lesson 2. We do not encourage the use of 11-0 or 12-0 threads on latex gloves, the finesse required takes far more experience than a trainee could possiibly develop within the first hours in the laboratory and given the price of the threads, we strongly oppose their being used at this point in training. For the more gifted ones, such threads may be compulsory in a petal-suturing setting (lesson 3).
More videos to come!
Song: Mozart Requiem. I do not own or claim authorship for the song.
