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CC BY-NC 4.0 · Arch Plast Surg 2021; 48(04): 427-432
DOI: 10.5999/aps.2020.01949
Extremity/Lymphedema
Idea and Innovation

Lymphovenous anastomoses with three-dimensional digital hybrid visualization: improving ergonomics for supermicrosurgery in lymphedema

Patrick A. Will 
Department of Hand, Plastic, and Reconstructive Surgery, Microsurgery, Burn Centre, BG-Trauma Hospital Ludwigshafen, Ludwigshafen am Rhein, Germany
Department of Plastic Surgery, Medical Faculty, University of Heidelberg, Heidelberg, Germany
,
Christoph Hirche 
Department of Hand, Plastic, and Reconstructive Surgery, Microsurgery, Burn Centre, BG-Trauma Hospital Ludwigshafen, Ludwigshafen am Rhein, Germany
Department of Plastic Surgery, Medical Faculty, University of Heidelberg, Heidelberg, Germany
Department of Plastic, Hand, and Reconstructive Microsurgery, Hand Trauma and Replantation Center, BG Unfallklinik Frankfurt am Main, Goethe University Frankfurt, Frankfurt am Main, Germany
,
Juan Enrique Berner 
Kellogg College, University of Oxford, Oxford, UK
Department of Plastic Surgery, Royal Victoria Infirmary, Newcastle upon Tyne, UK
,
Ulrich Kneser 
Department of Hand, Plastic, and Reconstructive Surgery, Microsurgery, Burn Centre, BG-Trauma Hospital Ludwigshafen, Ludwigshafen am Rhein, Germany
Department of Plastic Surgery, Medical Faculty, University of Heidelberg, Heidelberg, Germany
,
Emre Gazyakan 
Department of Hand, Plastic, and Reconstructive Surgery, Microsurgery, Burn Centre, BG-Trauma Hospital Ludwigshafen, Ludwigshafen am Rhein, Germany
Department of Plastic Surgery, Medical Faculty, University of Heidelberg, Heidelberg, Germany
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The conventional approach of looking down a microscope to perform microsurgical procedures is associated with occupational injuries, anti-ergonomic postures, and increased tremor and fatigue, all of which predispose microsurgeons to early retirement. Recently, three-dimensional (3D) visualization of real-time microscope magnification has been developed as an alternative. Despite its commercial availability, no supermicrosurgical procedures have been reported using this technology to date. Lymphovenous anastomoses (LVAs) often require suturing vessels with diameters of 0.2–0.8 mm, thus representing the ultimate microsurgical challenge. After performing the first documented LVA procedure using 3D-augmented visualization in our unit and gaining experience with this technique, we conducted an anonymized in-house survey among microsurgeons who had used this approach. The participants considered that 3D visualization for supermicrosurgery was equivalent in terms of handling, optical detail, depth resolution, and safety to conventional binocular magnification. This survey revealed that team communication, resident education, and ergonomics were superior using 3D digital hybrid visualization. Postoperative muscle fatigue, tremor, and pain were also reduced. The major drawbacks of the 3D visualization microscopic systems are the associated costs, required space, and difficulty of visualizing the lymphatic contrast used.

Keywords

Lymphedema - Microsurgery - Ergonomics - Digital hybrid visualization - Imaging, three-dimensional


Publication History

Received: 12 October 2020

Accepted: 26 March 2021

Article published online:
21 March 2022

© 2021. The Korean Society of Plastic and Reconstructive Surgeons. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonCommercial License, permitting unrestricted noncommercial use, distribution, and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes. (https://creativecommons.org/licenses/by-nc/4.0/)

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