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A Manual of Basic Microsurgical Techniques
This is a praccal surgical manual providing a step-by-step guide to basic micro­surgical techniques for the reconstrucon of small vessels, nerves and vas def­erens. This also includes access to videos demonstrang core microsurgical techniques.
Incorporang 40 years of experience gained by the teachers of the microvascular course at Northwick Park, the techniques described in this manual have trained generaons of surgeons. Fully illustrated and with a clear, succinct text, this manual will enable the reader to master basic skills quickly and condently.
Microsurgery is not dicult, provided it is taught properly: There is no magic formula, but it must be learnt slowly, paently and step by step. This valu­able resource will be useful for surgeons in training and in pracce and for research workers who are increasingly using microsurgical techniques in their experiments.
A Manual of Basic Microsurgical Techniques
Sandra Shurey Sital Vara Abdul Ahmed
First edion published 2024 by CRC Press 2385 NW Execuve Center Drive, Suite 320, Boca Raton FL 33431
and by CRC Press 4 Park Square, Milton Park, Abingdon, Oxon, OX14 4RN
CRC Press is an imprint of Taylor & Francis Group, LLC
© 2024 Sandra Shurey, Sital Vara, Abdul Ahmed
This book contains informaon obtained from authenc and highly regarded sources. While all reasonable eorts have been made to publish reliable data and informaon, neither the author[s] nor the publisher can accept any legal responsibility or liability for any errors or omissions that may be made. The publishers wish to make clear that any views or opinions expressed in this book by individual editors, authors or contributors are personal to them and do not necessarily reect the views/opinions of the publishers. The informaon or guidance contained in this book is intended for use by medical, scienc or health­care professionals and is provided strictly as a supplement to the medical or other professional’s own judgement, their knowledge of the paent’s medical history, relevant manufacturer’s instrucons and the appropriate best pracce guidelines. Because of the rapid advances in medical science, any informaon or advice on dosages, procedures or diagnoses should be independently veried. The reader is strongly urged to consult the relevant naonal drug formulary and the drug companies’ and device or material manufacturers’ printed instrucons, and their websites, before administering or ulizing any of the drugs, devices or materials menoned in this book. This book does not indicate whether a parcular treatment is appropriate or suitable for a parcular individual. Ulmately it is the sole responsibility of the medical professional to make his or her own professional judgements, so as to advise and treat paents appropriately. The authors and publishers have also aempted to trace the copyright holders of all material reproduced in this publicaon and apologize to copyright holders if permission to publish in this form has not been obtained. If any copyright material has not been acknowledged please write and let us know so we may recfy in any future reprint.
Except as permied under U.S. Copyright Law, no part of this book may be reprinted, reproduced, transmied, or ulized in any form by any electronic, mechanical, or other means, now known or hereaer invented, including photocopying, microlming, and recording, or in any informaon storage or retrieval system, without wrien permission from the publishers.
For permission to photocopy or use material electronically from this work, access www.copyright.com or contact the Copyright Clearance Center, Inc. (CCC), 222 Rosewood Drive, Danvers, MA 01923, 978-750-8400. For works that are not available on CCC please contact mpkbookspermissions@tandf.co.uk
Trademark noce: Product or corporate names may be trademarks or registered trademarks and are used only for idencaon and explanaon without intent to infringe.
ISBN: 9781032536743 (hbk) ISBN: 9781032535760 (pbk) ISBN: 9781003413080 (ebk)
DOI: 10.1201/9781003413080
Typeset in Calibri by KnowledgeWorks Global Ltd.
Videos can be accessed via QR code on Video List page or the following link:
hps://www.youtube.com/@microshuremicrosurgery483/videos
Contents
Video list vi Introduction vii Authors ix
1 Equipment 1
2 Instruments 6
3 Stch formaon 13
4 Microsurgical training models 25
5 Animal model 28
6 Factors aecng anastomoc success 32
7 End-to-end arterial anastomosis 40
8 End-to-side anastomosis 56
9 Interposional vein gra 67
10 Vessels under 1 mm 79
11 Anastomosis with single clamps 95
12 Connuous suturing techniques 104
13 End-to-side connuous suturing 115
14 Peripheral nerve repair 127
15 Rat vasovasostomy 135
16 Rat epididymovasostomy 142
17 Clinical pracce 149
Index 157
Video list
Access to surgical videos demonstrang surgical techniques, together with step-by-step teaching modules to illustrate the techniques, is available via QR code.
hps://www.youtube.com/@microshuremicrosurgery483/videos
Teaching Modules
Module 1 The operang microscope
Module 2 Instruments and suture
Module 3 Stch formaon and suture
exercises
Module 4 Training models
Module 5 Factors aecng anastomoc
success
Module 6 End-to-end arterial anastomosis
Module 7 End-to-end venous anastomosis
Module 8 End-to-side anastomosis
Module 9a Interposional discrepant vein
gra
Module 9b Interposional vein gra
Module 10 Under 1 mm end-to-end
anastomosis
Module 11 Under 1 mm end-to-side
anastomosis
Module 12 Femoral artery to carod loop
Module 13 End-to-end arterial and venous
anastomosis with single clamps
Module 14 End-to-end anastomosis with
connuous suturing
Module 15 Renal model with end-to-end
connuous suturing
Module 16 Renal model with end-to-side
connuous suturing
Module 17 Vasovasostomy
Module 18 Epididymovasostomy
Module 19 Nerve repair
Surgical Techniques
Video 0 Femoral vessel preparaon
Video 1 End-to-end arterial
microanastomosis
Video 2 End-to-end vein
Video 3 End-to-side anastomosis
Video 4 Discrepant vein gra
Video 5 Epigastric vein gra
Video 6 Nerve anastomosis
Video 7 Groin ap on the epigastric
pedicle
Video 8 Groin ap end-to-side
anastomosis
Video 9 1 mm arterial anastomosis
ulising single clamps
Video 10 2 mm venous anastomosis
ulising single clamps
Video 11 Artery anastomosis ulising
connuous suturing
Video12 Vein anastomosis with
connuous suturing
Video 13 Carod loop anastomosis
Video 14 Renal harvest
Video 15 End-to-end renal transplant with
connuous suturing
Video 16 Renal transplant with end-to-
side connuous suturing
Video 17 Vasovasostomy
Video 18 Vasoepididymostomy
Introduction
The object of this manual is to provide a step-by-step guide to basic microsurgical techniques for reconstrucon of small vessels, nerves and vas deferens. Over the last 40 years we have absorbed, dislled and reworked informaon in light of experiments and research. The microvascular course at Northwick Park/Grin Instute is the old­est in the country (began in 1979) and has been running for over 40 years, having trained generaons of surgeons.
The need for microsurgical training in the UK was insgated by Prof. Colin Green, who was using microsurgical techniques in his experimental rabbit renal transplantaon, and by three young, like-minded plasc surgeons – Michael Black, Gus McGrowther and Roy Saunders (all now professors!).
They realised that with the advent of clinical free aps, the microsurgical aspect could not be acquired without some sort of formal training, and so the microvascular course was born.
I (Sandra Shurey) was there from the beginning and was mentored and encouraged by Prof. Green, who gave me the condence to pursue a career in surgical research and microsurgery, and I owe everything since then to his wonderful guidance.
Northwick Park Microsurgical Workshop, 1979
viii
Introduction
We hope the manual will be useful for surgeons in training and pracce and for research workers who are increasingly using microsurgical techniques in their experiments.
Some of the exercises would not be used clinically but are designed to enhance the microsurgical skills gained in a pracce situaon.
Microsurgery is not dicult, provided it is taught properly: There is no magic formula, but it must be learnt slowly, paently and step by step.
In 1 week (~35 hours), it is possible for the average surgeon to master basic skills and, more importantly, prove to themselves that they are capable of doing them.
Northwick Park Microsurgical Workshop, 2023
Authors
Sandra Shurey, MPhil, is a Research Surgeon and the Co-Author of the training manual Basic Microsurgical Techniques. She has over 40 years of experience teach-
ing microsurgery and to date has tutored over 4,000 surgeons from many diering speciales. She has had one manual, three book chapters and over 50 research papers published and has lectured internaonally on microsurgical techniques. She has honed her microsurgical skills from a research background in organ transplanta­on (heart, lung, kidney, liver, pancreas and small bowel), also including free-ap, muscle transplantaon, vasovasostomy, epididymovasostomy and nerve regen­eraon. She has also contributed to the assessment of microsurgical skills and to idenfying the ‘gold standard’ for the running of microsurgical workshops through-
out Europe. She also tutored microsurgery to medical MSc students from Imperial
College, UCL and Queen Mary University and was nominated for an Honorary Lec- tureship at Queen Mary’s. In 2016 when she rered, she started her own microsur­gical training company: MicroShure Microsurgery and now teaches on a 1:1 basis from her home in Devon. She is sll called upon for surgical research projects and sll teaches and lectures on microsurgery at hospitals when requested.
Sital Vara, BSc, PGCert, is a Surgical Trainer and Research Surgeon and the current Director
of the Northwick Park Microvascular course. Sital Vara has a background in surgical research, including wound-healing models, aneurysm repair and surgical implants. She has over 10 years of experience in small and large animal anaesthesia. She is an Honorary Lecturer for UCL and teaches undergraduate and postgraduate students basic surgical skills, includ­ing endoscopy, laparoscopy, microvascular surgery and roboc skills. Dr Vara has a passion for training and educaon and is involved in the organisaon, management and connued
development of various surgical training courses, including endovascular aneurysm repair
courses, the London free-ap course and craniofacial trauma courses.
Abdul Ahmed, BDS, MFDSRCS, MBChB, MRCS, DO-HNS, PGCert, FRCS(OMFS), is a
Consultant at OMFS/Head & Neck/Reconstrucve/Roboc Surgeon. He is an Hon- orary Professor, Senior Clinical Lecturer at Queen Mary University of London and a Clinical Tutor at the Grin Instute Surgical Training & Medical Research Charity.
Bringing almost a decade of consultant experience in OMFS and head and neck surgery, Prof. Ahmed exhibits an innovave approach to his pracce. He incorpo­rates cung-edge technologies, such as 3D planning, augmented reality (AR) and roboc surgery, into his work. With a notable repertoire, he has authored mulple textbooks and regularly imparts his knowledge through teaching engagements, including courses centered around microvascular surgery, reconstrucve surgery and undergraduate/postgraduate training for several universies.