Abstract
Surgical technique and technology frequently coevolve. The brief history of blood vessel anastomosis is full of famous names. While the techniques pioneered by these surgeons have been well described, the technology that facilitated their advancements and their inventors deserve recognition. The mass production of laboratory microscopes in the mid-1800s allowed for an explosion of interest in tissue histology. This improved understanding of vascular physiology and thrombosis laid the groundwork for Carrel and Guthrie to report some of the first successful vascular anastomoses. In 1916, McLean discovered heparin. Twenty-four years later, Gordon Murray found that it could prevent thrombosis when performing end-to-end anastomosis. These discoveries paved the way for the first-in-human kidney transplantations. Otolaryngologists Nylen and Holmgren were the first to bring the laboratory microscope into the operating room, but Jacobson was the first to apply these techniques to microvascular anastomosis. His first successful attempt in 1960 and the subsequent development of microsurgical tools allowed for an explosion of interest in microsurgery, and several decades of innovation followed. Today, new advancements promise to make microvascular and vascular surgery faster, cheaper, and safer for patients. The future of surgery will always be inextricably tied to the creativity and vision of its innovators.
Highlights
Achieving successful anastomosis of blood vessels is critical for many modern surgical procedures
Murphy in the United States utilized the current medical understanding of aseptic technique and vessel physiology to build on the preliminary success of Jassinowsky and develop a new technical framework for blood vessel anastomosis [5,9]. He utilized the histomechanical principle of Thoma—which states that as vessel caliber is decreased, vessel wall tension decreases—to develop the invagination method of vascular anastomosis, which found some success in his animal models (Figure 1a) [9]
Microvascular and vascular anastomosis can be performed on vessels of practically every size with consistently excellent results
Summary
Achieving successful anastomosis of blood vessels is critical for many modern surgical procedures. In a 1761 letter to Dr William Hunter, Richard Lambert of Newcastle upon Tyne reported a successful repair of a small tear in the brachial artery by approximating the wound edges with a small steel pin His results could not be replicated, and attempts at vascular anastomosis were shelved for over a century [5]. Recognizing the need to bring experienced scientists to his lab to improve his microscopes, he hired a professor of physics from Jena University, Ernst Abbe, as Director of Research in 1866 By employing his own equation, which would become known as ‘Abbe’s Sine Condition’, Abbe was able to consistently produce accurate, standardized lenses for every microscope created by the company. With improved tools and a growing body of knowledge, surgeons were poised to complete the first successful vascular anastomosis
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