Vessel Microanastomosis with 3D vs. Conventional Microscope: Which One is Better?
Samyd S. Bustos, MD1, Krishna S. Vyas, MD, PhD, MHS1, Joseph Banuelos, MD1, Megan Nelson, MD1, Brian Carlsen, MD1, Mark E. Morrey, MD1, Pedro Ciudad, MD, PhD2, Hung-Chi Chen, MD, PhD, FACS3, Oscar J. Manrique, MD1.
1Mayo Clinic, Rochester, MN, USA, 2Arzobispo Loayza National Hospital, Lima, Peru, 3China Medical University Hospital, Taichung, Taiwan.
BACKGROUND: In recent years, technological advances have improved the quality of microsurgical instruments, 3D microscopes, robotic technology and audiovisuals such as virtual reality (VR).This technology can potentially make things technically easier and improve our surgical outcomes. Our goal was to prospectively analyze and compare the outcomes of senior plastic surgery residents using 3D versusconventional microscope while performing a vessel microanastomosis. METHODS: In this crossover study based on a pig model, 12 senior plastic surgery residents over the course of 2 years were evaluated prospectively on performing microanastomosis in 1- 4 mm vessels with 3D and conventional microscopes. Metrics including time to perform the microanastomosis, patency of the vessels, size of the vessels and number of revisions of the microanastomosis were recorded. In addition, a survey was performed to obtain feedback regarding resident performance. Fischer’s exact t-test was utilized to compare the two microscopes. RESULTS: The average time to perform the microanastomosis was 73 minutes (range 62-85 mins) for the 3D microscope and 58 minutes (range 50-61 min) for the conventional microscope (p<0.002). Patency of the vessels was analyzed in the animal model the day after surgery with a 82% vs 95% patency rate respectively (p<0.005).The average size of the vessels was 2mm (range 1-4mm) for both groups. The number of revisions was doubled for the 3D microscope when the anastomosis was performed in vessels smaller than 2mm (p<0.005). However, there was no statistical difference for vessels larger than 3mm. Regarding feedback from the survey, the main complaints were looking at the monitor instead of through the binocular lens, difficulty seeing intraluminally for vessels of 2mm or less, low quality resolution images for the 3D scope and adapting to the new system. The most common complications seen were microthrombi and very small intimal flaps at the anastomosis site. Complication rate was significant on smaller vessels (>2mm). CONCLUSIONS: Based on these results, the use of the 3D microscope is feasible for larger vessels. However, for smaller caliber vessels and supermicrosurgery, the complication rate and outcomes are not as good as the conventional microscope. Further training and improvement in current technology might decrease the steep learning curve and expand its use for more complex cases.
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