Surgical procedures that use magnifying equipment and tiny surgical instruments to operate on small or delicate structures

Microsurgery makes it possible to perform operations on extremely small or delicate tissues in the body. In this form of surgery, a surgeon uses a binocular microscope to view the operating site and specially adapted small operating instruments. Using microsurgery, delicate surgical procedures can be carried out that would be difficult or impossible with other surgical techniques.

When is it used?

Microsurgery is most commonly used to operate on tissues such as nerves and blood vessels and on small structures in the eye, middle ear, and reproductive system. For example, microsurgery can be used to repair a detached retina (see Retinal detachment). It can also be used to remove the diseased eye lens of someone with a cataract and replace it with an artificially made lens (see Cataract surgery). In the disorder otosclerosis, deafness may occur when a bone in the middle ear becomes diseased and is unable to transmit sound. Hearing can be restored using microsurgery to replace the diseased bone with an artificial substitute.

During an operation to reattach a severed limb or digit, microsurgery is used to reconnect severed nerves and blood vessels. Microsurgery is also used to try to reverse two sterilization procedures: tubal ligation in women (see Female sterilization) and vasectomy in men. Sterilization in women involves cutting or sealing the fallopian tubes. In a vasectomy, the narrow tubes that carry sperm from the testes to the penis are severed, preventing the release of sperm. In both cases, micro-surgery procedures can be used to rejoin the sealed or severed tubes accurately, and, in many cases, a person’s reproductive function can be restored.

What happens during the operation?

Microsurgery is normally carried out under general anaesthesia (see Having a general anaesthetic). However, regional or local anaesthesia (see Having a regional anaesthetic, and Having a local anaesthetic) may be used for some minor surgical procedures, such as cataract operations.

During the operation, the surgeon views the operating site through a binocular microscope, which is operated using foot pedals. This leaves his or her hands free to use small precision instruments, including scissors, forceps, and clamps (see Having microsurgery). To repair nerves and blood vessels, small needles and fine thread are used to make tiny stitches.

What are the risks?

Any type of surgery involves some risk, whether from a reaction to the anaesthetic, excessive bleeding, formation of blood clots, or infection. Some microsurgical operations take longer to carry out than other similar surgical procedures, which means that the time under anaesthesia is longer. This increases the risk of adverse reaction to the anaesthetic and may extend the recovery time from anaesthesia. The risk of infection may be greater with microsurgery since the operating site is exposed for a relatively long time compared with other procedures.

There is a high success rate for many of the most routine microsurgical procedures, such as cataract removal and repair of retinal detachment. However, some procedures, such as reattachment of severed limbs or reversal of female sterilization, have lower success rates, which are partly determined by the extent of the tissue damage. Nevertheless, without microsurgery, operations such as these could not be attempted.

Procedure: Having Microsurgery

From the 2010 revision of the Complete Home Medical Guide © Dorling Kindersley Limited.

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