Microsurgery: Basic Techniques Used

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Essentially, microsurgery is the surgery done on very small structures like blood vessels and nerves.

It makes use of specialized instruments used under a microscope.

Today, techniques used in microsurgery are already utilized by a wide variety of surgical specialties.

For instance:


Takes advantage of microsurgical techniques when reversing vasectomies.


Reverses tubal ligations utilizing microsurgical techniques.

Ophthalmologists (eye doctors)

Carries out microsurgery when removing cataracts, carrying out corneal transplants, and treating eye conditions like glaucoma.

Otolaryngologists (ear, nose, and throat doctors)

Performs microsurgery on the small and delicate structures found in the inner ear or the vocal cords.

Plastic surgeons also employ microsurgical techniques to reconstruct damaged or disfigured tissues, muscles, and skin.

They also use microsurgical techniques when transplanting tissues from different parts of the patient’s body.

Neurosurgeons also perform microsurgery to treat vascular abnormalities in the brain.

It is also used when removing cancerous tumors.

Equipment Used

Microsurgical equipment magnifies the operating field, provides instrumentation, and makes it easy for the surgeon to carry out surgery on structures that are very small and barely visible to the naked eye.

Microsuture materials, microscope, and microsurgical instruments are considered the most essential tools used in the procedure.


While microscopes used in the procedure can vary depending on their specific use, they still have common standard features.

Microscope used in microsurgery has a moveable arm so manipulating its position is easier for the surgeon.

It can also be mounted on the ceiling or on the floor.

A high-intensity light source as well as a set of lenses makes it possible for the surgeon to view the surgical site.

A video camera makes it possible for the rest of the surgical team to see the operating field.

Generally, a five to forty times (5–40x) magnification is needed when carrying out microsurgery.

However, lower magnifications are used when exposing and identifying structures.

Higher magnifications are required when performing microsurgical repairs.


Generally, microsurgical instruments are able to delicately manipulate structures.

However, they also come equipped with handles that are large enough so they can be handled comfortably and securely.

Some of the most common instruments used in microsurgery include:

  • Forceps
  • Scissors
  • Needle holders
  • Vessel dilators
  • Vascular clamps
  • Irrigators

Suture Materials

Suturing or stitching is carried out utilizing specialized threads and needles.

The diameter or the gauge of the suture thread will vary depending on the tissue that needs suturing and the procedure that will be performed.

In most cases, in microsurgery gauges of 9–0 to 12–0 are used.

On the other hand, suture threads can be absorbable or non-absorbable.

They can also be synthetic or natural.

The suture thread that will be used will also depend on the procedure that will be done as well as the tissue that needs to be sutured.

Essential Techniques

Microsurgical procedures use a set of basic techniques that has to be mastered by the surgeon.

These techniques include nerve repair and grafting, blood vessel repair, and vein grafting.

Blood vessel repair

When two separate vessels are connected to form a continuous channel, the procedure is called vascular anastomosis.

Anastomoses may be end-to-end (between two cut ends) or end-to-side (one cut end to the wall of another blood vessel).

Vein grafting is an alternative procedure to end-to-end anastomosis.

However, the procedure is only carried out when the cut ends of the blood vessels cannot be reattached without creating any tension.

Nerve repair

Anastomosis or neurorrhaphy is the procedure done when two cut ends of a nerve are connected.

Nerve repair may also involve suturing of the epineurium or the perineurium.

Nerve grafting

Neurorrhaphy cannot be carried out when there is a large gap between the cut ends of the nerve as tension might be created.

Nerve tension is avoided as it might interfere with the patient’s post-surgical function.

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