Microsurgery - Overview
Microsurgical techniques offer to surgeons a great
improvement in working conditions to achieve the effective
surgery of intracranial aneurysms and other small lesions,
and an improved outcome for patients.
Microsurgery, however, requires a clear definition:
it is not just the sole use of a microscope during a
conventional neurosurgical exploration. It is an entirely
new surgical discipline and concept requiring the use
of a mobile counter-balanced operating microscope, and
necessitating mastery of indirect eye-hand interaction
which can only be acquired in a specially equipped laboratory.
Microneurosurgery constitutes two main components:
1. Special equipment:
- Counter-balanced mobile operating microscope equipped
with a mouth-switch which allows free manual surgical
manipulations during the entire procedure and T.V.
camera and monitors to enhance and promote team work
in the operating room between surgeon, neuroanesthesiologist,
nurses, and technicians.
- Bipolar coagulators and bipolar forceps of different
lengths and tip size.
- Pressure regulated suction apparatus and suction
tubes in different lengths and diameters.
- Bayonet-shaped surgical instruments in different
lengths and tip sizes and malleable microinstruments.
- Variety of temporary and permanent aneurysm and
vessel clips and applications. There are now 180 different
- Microsutures and special needle holders.
- Self-retaining "protective" brain retractors.
- Hydraulic chair and adjustable arm rest for the
2. Special surgical techniques requiring laboratory
training to perfect:
- Enhanced eye-hand interaction working under conditions
of indirect vision with the operating microscope.
- Delicate manipulation with microinstruments during
dissection, clipping, coagulating, neurovascular repair,
- Tactics to operating within a key-hole approach
performing the procedures as mentioned above; but,
under more difficult conditions, for example plastic
boxes of different heights (5-12 cm) and with narrow
openings cm diameter) simulate deep narrow approaches
within and around the brain.
- Delicate and controlled manipulations within the
confines of a small gap and using a self-retaining
protective brain retractor.
- Training the use and applications of the bipolar
coagulator and microsuction equipment.
- Exercises for the creation of an aneurysm and arteriovenous
fistula on the carotid artery or aorta of a laboratory
rat; practicing the technique of application of temporary
and permanent clips and the technique of bipolar coagulation
to shrink the different parts of the created vascular
anomaly, to form in the case of an aneurysm, a suitable
neck from the original wide base, which is more amenable
to precise placement of a clip.
- Training to develop expertise and comfort using
high-speed surgical drills.
Mr D'Urso utiltises the Zeiss OPMI/NC4 microscope system
for his microsurgery at The Epworth Hospital. Legendary
optics have always been the hallmark of surgical microscopes
from Carl Zeiss. Carl Zeiss optics ensure outstanding
colour fidelity, razor-sharp, crisp imagery and an unprecedented
level of detail. A new zoom design delivers amazing
depth of field and reduces eyestrain and the need to
refocus. Integrated high-accuracy autofocus quickly
produces a perfect image every time. Amazing light transmission
and a unique two-way light path illumination to reduce
shadows ensures the best possible vision.
For cross-table, face-to-face procedures, the NC4 can
be placed conveniently behind the surgeon in the overhead
Back to Top