Application Of Microsurgery Research Articles

Decoding the Impact of AI on Microsurgery: Systematic Review and Classification of Six Subdomains for Future Development.

The advent of artificial intelligence (AI) in microsurgery has tremendous potential in plastic and reconstructive surgery, with possibilities to elevate surgical precision, planning, and patient outcomes. This systematic review seeks to summarize available studies on the implementation of AI in microsurgery and classify these into subdomains where AI can revolutionize our field. Adhering to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, a meticulous search strategy was used across multiple databases. The inclusion criteria encompassed articles that explicitly discussed AI's integration in microsurgical practices. Our aim was to analyze and classify these studies across subdomains for future development. The search yielded 2377 articles, with 571 abstracts eligible for screening. After shortlisting and reviewing 86 full-text articles, 29 studies met inclusion criteria. Detailed analysis led to the classification of 6 subdomains within AI applications in microsurgery, including information and knowledge delivery, microsurgical skills training, preoperative planning, intraoperative navigational aids and automated surgical tool control, flap monitoring, and postoperative predictive analytics for patient outcomes. Each subtheme showcased the multifaceted impact of AI on enhancing microsurgical procedures, from preoperative planning to postoperative recovery. The integration of AI into microsurgery signals a new dawn of surgical innovation, albeit with the caution warranted by its nascent stage and application diversity. The authors present a systematic review and 6 clear subdomains across which AI will likely play a role within microsurgery. Continuous research, ethical diligence, and cross-disciplinary cooperation is necessary for its successful integration within our specialty.

Advances in Modern Microsurgery.

Background/Objectives: Microsurgery employs techniques requiring optical magnification and specialized instruments to operate on small anatomical structures, including small vessels. These methods are integral to plastic surgery, enabling procedures such as free tissue transfer, nerve reconstruction, replantation, and lymphatic surgery. This paper explores the historical development, advancements, and current applications of microsurgery in plastic surgery. Methods: The databases MEDLINE (via PubMed) and Web of Science were selectively searched with the term "(((microsurgery) OR (advances)) OR (robotic)) OR (AI)) AND (((lymphatic surgery) OR (peripheral nerve surgery)) OR (allotransplantation))" and manually checked for relevance. Additionally, a supplementary search among the references of all publications included was performed. Articles were included that were published in English or German up to June 2024. Results: Modern microsurgical techniques have revolutionized plastic surgery, enabling precise tissue transfers, improved nerve reconstruction, and effective lymphedema treatments. The evolution of robotic-assisted surgery, with systems like da Vinci and MUSA, has enhanced precision and reduced operative times. Innovations in imaging, such as magnetic resonance (MR) lymphography and near-infrared fluorescence, have significantly improved surgical planning and outcomes. Conclusions: The continuous advancements in microsurgery, including supermicrosurgical techniques and robotic assistance, have significantly enhanced the capabilities and outcomes of plastic surgery. Future developments in AI and robotics promise further improvements in precision and efficiency, while new imaging modalities and surgical techniques expand the scope and success of microsurgical interventions.

Interface Allocation Precisely Customized Janus Upconversion Nanomotor for Atherosclerosis Amelioration

AbstractSpatial and temporal precisely control of direction and speed is crucial for nanomotors to enable complex operations and applications in microsurgery, drug delivery, isolation of biological targets, and so on. Judicious material design involving Janus nanoparticles has been popular over the past decades, however, precise and customizable modulation of Janus structure with a specific asymmetric ratio for motion control is still challenging. In this study, a universal “interface allocation” strategy is developed for efficient and controllable preparation of Janus mesoporous silica‐coated upconversion nanoparticles (Janus UCNP@mSiO2) with precisely tuned asymmetric ratio to achieve near‐infrared (NIR)‐controlled active mobility for relieving vessel plaque. Mesoporous silica with a thickness of 50 nm is precisely coated onto the nanoparticles’ surface with an optimal coverage ratio of 50% to encapsulate gas propellant. Upon exposure to upconverted blue light, the nanomotors release nitric oxide, facilitating their motion and pathologically improving atherosclerosis through endothelium‐dependent vasodilation. Experimental and theoretical simulation results demonstrate the advantages of NIR‐controlled Janus upconversion nanomotors in atherosclerosis treatment, including enhanced nanoparticle‐transmittance rate (34.83% to 85.57%) and excellent in vivo therapeutic efficacy.

Tissue-engineered cellulose tubes for microvascular and lymphatic reconstruction: A translational and feasibility study

BackgroundLymphedema microsurgery is an emerging treatment modality, with dissimilar long-term outcomes. One of the main technical challenges in lymphatic microsurgery is the identification and availability of suitable donor vessels for anastomosis. Tissue engineering using biomaterials has shown promise in addressing vessel quality issues in other fields, but its application in microsurgery is still limited. MethodsDecellularized cellulose tubes were developed and bioengineered by decellularizing stems of Taraxacum-Ruderalia. The microscopic structure, mechanical properties, and remnant DNA content of the cellulose tubes were evaluated. Human and murine skin fibroblasts and dermal lymphatic endothelial cells were isolated and cultured for recellularization studies. Biocompatibility, proliferative capacity, and ex-vivo endothelialization of the cellulose tubes were assessed as potential interposition grafts. Finally, the engineered cellulose tubes were assessed as interposing xenografts for LVA in an ex-vivo swine limb model. ResultsThe decellularized cellulose tubes exhibited a suitable microscopic structure, mechanical properties, and low remnant DNA content. The tubes showed adequate biocompatibility, supported cell proliferation, and facilitated spontaneous ex-vivo endothelialization of lymphatic endothelial cells. In the swine limb model, LVA using the engineered cellulose tubes was successfully performed. ConclusionThis translational study presents the use of decellularized cellulose tubes as an adjunct for micro and supermicrosurgical reconstruction. The developed tubes demonstrated favorable structural, mechanical, and biocompatible properties, making them a potential candidate for improving long-term outcomes in lymphedema surgical treatment. The next translational step would be trialing the obtained tubes in a microsurgical in-vivo model.

Robotics in Microsurgery and Supermicrosurgery.

Microsurgery has changed the ability to perform highly precise and technical surgeries through the utilization of high-powered microscopes and specialized instruments to manipulate and repair anatomical structures as small as a few millimeters. Since the first human trials of robotic-assisted microsurgery in 2006, the expansion of microsurgery to supermicrosurgery (luminal diameter less than 1 mm) has enabled successful repair of previously inaccessible structures. Surgical robotic systems can offer two distinct operative advantages: (1) minimal access surgery-by entering body cavities through ports, flap harvest can be redesigned to affect a minimally invasive approach for flaps such as the rectus abdominis muscle, the latissimus flap, and the deep inferior epigastric perforator flap; and (2) precision-by eliminating physiologic tremor, improving ergonomics, increasing accessibility to difficult spaces, and providing motion scaling, precision is significantly enhanced. Robotic-assisted microsurgery is a promising application of robotics for the plastic surgeon and has played an important role in flap harvest, head and neck reconstruction, nerve reconstruction, gender-affirming surgery, and lymphatic reconstruction-all the while minimizing surgical morbidity. This article aims to review the history, technology, and application of microsurgery and supermicrosurgery in plastic surgery.

Vasodilating Effects of Antispasmodic Agents and Their Cytotoxicity in Vascular Smooth Muscle Cells and Endothelial Cells-Potential Application in Microsurgery.

This study aimed to elucidate the vasodilatory effects and cytotoxicity of various vasodilators used as antispasmodic agents during microsurgical anastomosis. Rat smooth muscle cells (RSMCs) and human coronary artery endothelial cells (HCAECs) were used to investigate the physiological concentrations and cytotoxicity of various vasodilators (lidocaine, papaverine, nitroglycerin, phentolamine, and orciprenaline). Using a wire myograph system, we determined the vasodilatory effects of each drug in rat abdominal aortic sections at the concentration resulting in maximal vasodilation as well as at the surrounding concentrations 10 min after administration. Maximal vasodilation effect 10 min after administration was achieved at the following concentrations: lidocaine, 35 mM; papaverine, 0.18 mM; nitroglycerin, 0.022 mM; phentolamine, 0.11 mM; olprinone, 0.004 mM. The IC50 for lidocaine, papaverine, and nitroglycerin was measured in rat abdominal aortic sections, as well as in RSMCs after 30 min and in HCAECs after 10 min. Phentolamine and olprinone showed no cytotoxicity towards RSMCs or HCAECs. The concentrations of the various drugs required to achieve vasodilation were lower than the reported clinical concentrations. Lidocaine, papaverine, and nitroglycerin showed cytotoxicity, even at lower concentrations than those reported clinically. Phentolamine and olprinone show antispasmodic effects without cytotoxicity, making them useful candidates for local administration as antispasmodics.

Retracted: Clinical Application of Microsurgery Using the Cerebellar Medulla Fissure Approach in Severe Ventricular Hemorrhage with Casting of the Fourth Ventricle and Its Influence on Neurological Recovery.

[This retracts the article DOI: 10.1155/2021/3699233.].

Small-Diameter Artificial Vascular Graft: Recent Progress and Its Potential Applications in Microsurgery

Small-Diameter Artificial Vascular Graft: Recent Progress and Its Potential Applications in Microsurgery

First Clinical Application in Microsurgery of Vascular Anastomoses and Flap Transplantation Via a Portable NIR-II Imaging System with ICG

First Clinical Application in Microsurgery of Vascular Anastomoses and Flap Transplantation Via a Portable NIR-II Imaging System with ICG

Clinical Application of Microsurgery Using the Cerebellar Medulla Fissure Approach in Severe Ventricular Hemorrhage with Casting of the Fourth Ventricle and Its Influence on Neurological Recovery.

Objective To investigate the clinical application of microsurgery using the cerebellar medulla fissure approach in severe ventricular hemorrhage with casting of the fourth ventricle and its effect on neurological recovery. Methods A total of 80 patients with severe intraventricular hemorrhage accompanied by casting and dilation of the fourth ventricle who were admitted to the neurosurgery department between July 2019 and December 2020 were randomly divided into an observation group and a control group, with 40 patients in each group. The drainage tube extubation time and length of hospital stay of the two groups were compared. The 3-day hematoma clearance of the two groups was observed. Postoperative consciousness was evaluated by GCS, and the patients' recovery was evaluated by GOS at three months. The activities of daily living (ADL) scores of the two groups were compared to evaluate patients' postoperative self-care ability. The incidence of postoperative complications in the two groups was collected. Independent risk factors for poor prognosis were analyzed by logistics regression. Results The postoperative hospitalization time and the drainage tube extubation time in the observation group were significantly lower than those in the control group. The ratio of hematoma clearance ≥90% in the observation group was significantly higher than that of the control group. Postoperative GCS scores and GOS scores in the observation group were significantly higher than those of the control group. The rate of postoperative complications in the observation group was significantly lower than that of the control group. The rate of good ADL grading in the observation group was significantly higher than that in the control group. Age and surgical method were independent risk factors for poor prognosis. Conclusion Microsurgery using the cerebellar medulla fissure approach can effectively improve the condition of severe ventricular hemorrhage with casting of the fourth ventricle and promote the recovery of patients' neurological function.

Development of a miniature objective based on calcium fluoride and zinc sulfide lenses for ultrafast laser microsurgery applications

Calcium fluoride and zinc sulfide crystals exhibit broad multispectral transparency and are used for a multitude of optical applications. However, they both belong to a soft brittle crystal category and are mechanically challenging to process. Thus, a fabrication protocol using a single-point diamond turning method was developed, which can yield surfaces with optical quality for these materials. By using a diamond turning tool with low waviness (≤100-nm waviness) and by using feed rates of 1 and 0.2 μm / rev, CaF2 and ZnS surfaces with surface roughness of 6 and 5 nm were manufactured, respectively. Design and fabrication of a miniature objective with 0.5 NA are also presented, which was developed for the ultrafast laser microsurgery application. The objective consists of CaF2 and ZnS lenses to withstand the high power from ultra-short laser pulses and to provide a tightly focused beam with 1.23 μm 1 / e2 spot radius for laser ablation. Based on the spot size measurement of the objective, its performance was considered to be near diffraction limited.

Thermal lensing effects and nonlinear refractive indices of fluoride crystals induced by high-power ultrafast lasers.

Thermo-optical and nonlinear property characterization of refractive optical components is essential for endoscopic instrumentation that utilizes high-power, high-repetition-rate ultrafast lasers. For example, ytterbium-doped fiber lasers are well suited for ultrafast laser microsurgery applications; however, the thermo-optical responses of many common lens substrates are not well understood at 1035 nm wavelength. Using a z-scan technique, we first measured the nonlinear refractive indices of CaF2, MgF2, and BaF2 at 1035 nm and found values that match well with those from the literature at 1064 nm. To elucidate effects of thermal lensing, we performed z-scans at multiple laser repetition rates and multiple average powers. The results showed negligible thermal effects up to an average power of 1 W and at 10 W material-specific thermal lensing significantly altered z-scan measurements. Using a 2D temperature model, we could determine the source of the observed thermal lensing effects. Linear absorption was determined as the main source of heating in these crystals. On the other hand, inclusion of nonlinear absorption as an additional heat source in the simulations showed that thermal lensing in borosilicate glass was strongly influenced by nonlinear absorption. This method can potentially provide a sensitive method to measure small nonlinear absorption coefficients of transparent optical materials. These results can guide design of miniaturized optical systems for ultrafast laser surgery and deep-tissue imaging probes.

Compact Vectorial Transverse Force Sensor Based on Two-Modal Interference in a Few-Mode Seven-Core Fiber

A compact and highly sensitive optical fiber vectorial transverse force sensor is proposed to simultaneously measure the magnitude and direction of the transverse force based on two-modal interference. The sensor consists of a few-mode seven-core fiber (FM-SCF) connected to a fan-in/out coupler. The calculation model for predicting the performance characteristics of the proposed FM-SCF sensor under transverse forces has been developed, and the different spectral shifts of its each core are theoretically and experimentally analyzed. The magnitudes and direction angles are investigated by calculating the dip wavelength shifts and its difference. The sensitivity of the force sensor of 17.527 nm/N and the minimum resolved force of 0.005N were observed experimentally. Additionally, it is able to detect the direction angle of the transverse force with an accuracy of 1.15°. The effect of temperature on the response of FM-SCF sensor can be eliminated while measuring the direction angles. The presented results indicate a great potential of the FM-SCF sensor applications of microsurgery.

Applications of microsurgery in periodontics

Periodontal microsurgery is an advance in the field of periodontal surgical procedures. It has been described as the methodology where there is modification and refinement of the existing surgical procedure with the use of magnification to improve visualization and has implications and applicability to all specialties. The criteria for the success of the treatments performed to improve esthetics may be different compared to the surgical procedures where the main goal is to improve periodontal health and restore the function. Therefore, the use of the surgical microscope in periodontal surgery is less documented with only few studies addressing the advantages of the application of magnification to periodontal surgery. The resource for the article was obtained through search in the web with the inclusion of case reports and comparative studies. This article presents an overview of magnifying tools available and their applications in periodontics.

One year Rat Study of iBTA-induced “Microbiotube” Microvascular Grafts With an Ultra-Small Diameter of 0.6 mm

The world's smallest calibre "microbiotube" vascular graft was recently developed, with an inner diameter of 0.6mm. It was formed using in-body tissue architecture (iBTA) and has a high degree of patency and capacity for regeneration in the acute phase, 1 month after implantation. This consecutive study investigated the compatibility and stability of microbiotubes in the chronic phase of implantation for 12 months for potential application in microsurgery. This was an invivo experimental study. The microbiotubes were prepared by embedding the mould subcutaneously in rats for 2 months. Allogenic microbiotubes (n=16) were implanted into the bilateral femoral arteries (inner diameter 0.5mm) of eight Wistar rats in an end to end anastomosis manner for 12 months. Follow up 7-Tesla magnetic resonance angiograms were performed every 3 months. Histological observation was performed 12 months after implantation. All patent grafts (n=12, patency 75%) one month after implantation maintained their patency up to 12 months without any abnormal morphological changes or calcification. Histological observation at 12 months showed that layered α-smooth muscle actin positive cells with a monolayer luminal covering of endothelial cells had formed from the proximal to the distal anastomoses. A thin elastic fibre layer formed in the luminal area. After implantation, all components of the microbiotube were similar to those of a native artery. This study suggests that microbiotubes have high compatibility, stability, and durability as replacement grafts over the short to mid-term period.

Periodontal Microsurgery and Microsurgical Instrumentation: A Review

AbstractIncreasing surgical refinement of procedures to meet both biologic and esthetic demands of patients is seen in today's periodontal practice. For these new technologies, instruments, and surgical techniques are necessary. Technical skills of the clinician are challenged by the limit of range of visual acuity. Periodontal microsurgery improves the outcome of basic periodontal surgical procedures by enhancing normal vision through magnification along with favorable lighting system. It gives enhanced outcomes not possible with traditional macrosurgery in terms of passive wound closure and reduced tissue trauma. The purpose of this review is to provide brief knowledge of periodontal microsurgery: the role of magnification, microsurgical instrumentation and applications of microsurgery.

Evolution and clinical application of microsurgery

Evolution and clinical application of microsurgery

Diode end-pumped passively Q-switched Tm:YAP laser with 1.85-mJ pulse energy.

Passive Q switching of a Tm:YAP solid-state laser at 1935 nm with Cr:ZnSe and Cr:ZnS polycrystalline saturable absorbers is demonstrated for the first time, to the best of our knowledge. With Cr:ZnS, a maximum pulse energy of 1.85 mJ is obtained for a pulse duration of 35.8 ns, resulting in a peak power of 51.7 kW. With Cr:ZnSe, the achieved pulse energy of 1.55 mJ with a pulse duration of 42.2 ns leads to 36.7-kW peak power. These high pulse energies, together with the unique lasing wavelength at 1935 nm, make this laser a promising tool for biomedical and microsurgery applications.

Smart surgical tool.

A laser-induced breakdown spectroscopy (LIBS) guided smart surgical tool using a femtosecond fiber laser is developed. This system provides real-time material identification by processing and analyzing the peak intensity and ratio of atomic emissions of LIBS signals. Algorithms to identify emissions of different tissues and metals are developed and implemented into the real-time control system. This system provides a powerful smart surgical tool for precise robotic microsurgery applications with real-time feedback and control.

Magnification in dental practice: How useful is it?

Microsurgery, this terminology itself is self-explanatory, where a surgical procedure is performed making use of the magnification obtained by an operating microscope. The instruments like a microscope which provides the magnification is made use of, in the fields of medicine since decades. Now the use of such magnification systems is a very popular practice in dentistry as well. Before adopting visual magnification systems such as microscopes and successfully applying it in the dental procedures, it is mandatory to understand the principles and the physics of such instruments. Microsurgery in dentistry has more advantages in terms of efficiency, improved ergonomics, minimally invasiveness and less fatigue. This review paper, highlights about the various magnification systems, its principles and the application of microsurgery in various fields of dentistry.