Microsurgical Interventions Research Articles

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.

Electrical Stimulation: Enhancing Axonal Growth following Peripheral Nerve Injury.

Electrical stimulation has been integrated in recent decades into rehabilitation protocols following neuromuscular injuries. Existing literature supports the utilisation of prolonged or continuous stimulation generated by implantable or transcutaneous devices for chronic pain subsidence and muscle trophism maintenance, which improve outcomes following microsurgical interventions. Newer uses include brief electrical stimulation for peripheral nerve injury. Brief electrical stimulation has shown promise in expediting regeneration of both torn and crushed nerve axons in the murine model and has been incorporated into a limited number of clinical studies. Augmentation of the natural response of an injured peripheral nerve by electrical stimulation has the potential to accelerate regeneration, presumably leading to improved function and clinical outcomes. We review the existing literature on intraoperative utilisation of electrical stimulation to enhance regeneration, such as neural mechanisms of action and their microscopic effect in animal models, as well as results from initial human studies. Level of Evidence: Level V (Therapeutic).

Pharmaceutical Modulation of Intracranial Aneurysm Development and Rupture.

Management of intracranial aneurysms (IAs) is determined by patient age, risk of rupture, and comorbid conditions. While endovascular and microsurgical interventions offer solutions to mitigate the risk of rupture, pharmacological management strategies may complement these approaches or serve as alternatives in appropriate cases. The pathophysiology of IAs allows for the targeting of inflammation to prevent the development and rupture of IAs. The aim of this review is to provide an updated summary of different pharmaceutical management strategies for IAs. Acetylsalicylic acid and renin-angiotensin-aldosterone system (RAAS) inhibitor antihypertensives have some evidence supporting their protective effect. Studies of selective cyclooxygenase-2 (COX-2) inhibitors, statins, ADP inhibitors, and other metabolism-affecting drugs have demonstrated inconclusive findings regarding their association with aneurysm growth or rupture. In this manuscript, we highlight the evidence supporting each drug's effectiveness.

Complementary advantages of microsurgical treatment for vertebral artery dolicoarteriopathies: Mitigating symptoms of restless leg syndrome in refractory vertebrobasilar insufficiency

Objective: This retrospective study examines the impact of microsurgical treatment on vertebral artery (VA) dolicoarteriopathies and associated restless leg syndrome (RLS) in patients with refractory vertebrobasilar insufficiency (VBI). Patients and Methods: We analyzed 78 patients with grade 2 and 3 kinks, and found out that the targeted microsurgical interventions, primarily designed to address VBI, improved secondary RLS symptoms in 12 patients. Procedures included arteriolysis and, depending on severity, grafting. Statistical analysis was conducted using Stata 16 (StataCorp LP, Texas, USA). Results: In twelve patients aged 55 to 72 years with refractory VBI and drug-resistant RLS, micro-neurosurgical correction of V1 segment dolicoarteriopathy, abnormal elongation and kinks in the artery, demonstrated promising outcomes. Postoperatively, 83.33% (10 patients) reported complete resolution of RLS symptoms, and 16.66% (2 patients) experienced partial symptom relief (p<0.05). Overall, 86.8% of various VBI-related symptoms were significantly improved or resolved (p<0.05). The microsurgical technique, avoiding traditional flow-arresting procedures, proved to be highly effective in this preliminary study with no mortality and minimal temporary complications, underscoring its potential treatment avenue for such complex neurovascular conditions. Conclusion: This study illuminates the relationship between VBI and RLS, proposing a potential vascular etiology for RLS, and highlights the need for a broader diagnostic approach for patients with refractory VBI.

Beyond Borders: A Global Microsurgery Training and Case Exposure Survey.

Microsurgery is essential in modern reconstructive surgery and plastic surgery training. Surgeon's proficiency and experience are crucial for effective microsurgical interventions. Despite anecdotal evidence of varying quality of microsurgery training globally, no empirical studies have investigated this. We conducted a global survey to investigate microsurgical training and clinical case exposure among plastic surgery trainees worldwide. An online survey was conducted using a secure platform to gather information on microsurgical case exposure and training among plastic surgery trainees between August 2020 and April 2021. Participants provided consent and completed a 37-question survey across four themes: clinical caseload, surgical exposure to microsurgery, microsurgical simulation training exposure, and barriers and opportunities. A total of 202 responses were received, with most respondents in formal training programs (86.7%). The data highlighted regional variation in microsurgery case indications and flap types, with North America and Europe exhibiting the highest activity levels in microsurgery. Trainees in Asia have the highest cumulative practical exposure in microsurgery, followed by Australia and Oceania, and North America. Only 39.6% of respondents reported formal microsurgical simulation training, and almost one-third (29.7%) received no simulation training. Trainee access to practical experience is limited by several factors, including insufficient time and procedure complexity. Notably, practical experience was most commonly denied without reason being given. Our study highlights significant disparities in microsurgical training and exposure among plastic surgery trainees globally. Further research is needed to identify strategies for addressing these issues, given the growing demand for complex reconstructive microsurgery and its impact on health care inequalities.

THE CURRENT STATE OF THE DEPARTMENT OF GENERAL AND EMERGENCY SURGERY DURING THE PERIOD OF MARTIAL LAW IN UKRAINE

Abstract. Medical work in wartime has its own peculiarities. Among the patients admitted to the clinic for treatment, the number of operations for primary treatment of wounds, necroctomy and amputation of limbs and fingers, removal of foreign bodies (bullets, fragments, glass, etc.), treatment of combined injuries of soft tissues with bone fractures, and others is increasing sharply. The use of VAC and pulse-VAC devices, ultrasonic cavitators, dermatomes, micro-instruments and suture material for microsurgical interventions is very important for the preparation of surgical wounds for reconstructive and restorative operations.

Acute spinal cord compression under systemic therapy - radiotherapy or surgery?

Vertebral bodies are one of the most common metastasis sites found in advanced prostate cancer and have a significant impact on patients' quality of life. Spinal metastases frequently cause severe back pain and in some occasions can lead to secondary complications, with serious neurological deficits and loss of function. The main treatment goals include adequate pain management, controlling tumour growth and restoring spinal stability. Publications on the role of surgery - both conventional and stereotactic radiotherapy, and either as an individual modality or in combination - have been inconclusive. The NOMS score has proven to be useful in making treatment decisions. Existing data show better outcomes in patients with surgical therapy, both when performed in isolation and also combined with radiotherapy, in which some of the cohorts studied including patients with primary cancer other than prostate cancer. Comparative studies that specifically investigate the superiority of specific therapy modalities for metastatic prostate carcinoma are scarce. Similarly, there are limited data on microsurgical interventions for spinal metastases. Radiotherapy alone is crucial in the setting of palliation, especially for pain relief, and its effectiveness has been shown in many studies. The patient's life expectancy plays a crucial role in deciding the most appropriate treatment approach. Given the complexity of the patient population, a multimodal therapy approach is necessary. Current trends in therapy favour greater use of surgical interventions, particularly in the early detection of spinal metastases.

The role of intraoperative ultrasound in management of spinal intradural mass lesions and outcome

BackgroundThe spinal intradural mass lesions represent a challenge in microsurgical practices. The intraoperative precise localization and characterization of these lesions must be achieved to avoid excessive exposure and neural tissue damage. This study aims to evaluate the role of intraoperative ultrasound during surgical dealing with spinal intradural mass lesions starting before bony work exposure.ResultsThis prospective study had been done during the period from January 2022 to January 2023 with follow-up at least 6 months on 36 patients, suffered intradural spinal mass lesions and underwent microsurgical interventions aided with intraoperative ultrasound. MRI spine and Klekamp score were used as preoperative and postoperative parameters for assessment of the patients. Intraoperative ultrasound features were analyzed to evaluate its values. All lesions were visualized and characterized by intraoperative ultrasound beside spinal anatomical identification. Laminoplasty, laminectomy, durotomy and myelotomy were determined by IOUS. Gross total eradication was achieved in 28/36 (78%). Intraoperative ultrasonography definition of cystic component, well-defined borders and smooth shape of the masses were associated with significant Klekamp outcome improvement.ConclusionIntraoperative ultrasound can be used safely to detect the spinal intradural mass lesions even before bony work for exposure with anatomical and pathological definition and has the ability to predict the outcome.

Pre- and Post-Microsurgical Rehabilitation Interventions and Outcomes on Breast Cancer-Related Lymphedema: a Systematic Review.

Breast cancer-related lymphedema (BCRL) is a debilitating progressive disease resulting in various impairments and dysfunctions. Complete decongestive therapy embodies conservative rehabilitation treatments for BCRL. Surgical procedures performed by plastic and reconstructive microsurgeons are available when conservative treatment fails. The purpose of this systematic review was to investigate which rehabilitation interventions contribute to the highest level of pre- and post-microsurgical outcomes. Studies published between 2002 and 2022 were grouped for analysis. This review was registered with PROSPERO (CRD42022341650) and followed the PRISMA guidelines. Levels of evidence were based upon study design and quality. The initial literature search yielded 296 results, of which, 13 studies met all inclusion criteria. Lymphovenous bypass anastomoses (LVB/A) and vascularized lymph node transplant (VLNT) emerged as dominant surgical procedures. Peri-operative outcome measures varied greatly and were used inconsistently. There is a dearth of high quality literature leading to a gap in knowledge as to how BCRL microsurgical and conservative interventions complement each other. Peri-operative guidelines are needed to bridge the knowledge and care gap between lymphedema surgeons and therapists. A core set of outcome measures for BCRL is vital to unify terminological differences in the multidisciplinary care of BCRL. Complete decongestive therapy embodies conservative rehabilitation treatments for breast cancer-related lymphedema (BCRL). Surgical procedures performed by microsurgeons are available when conservative treatment fails. This systematic review investigated which rehabilitation interventions contribute to the highest level of pre- and post-microsurgical outcomes. Thirteen studies met all inclusion criteria and revealed that there is a dearth of high quality literature leading to a gap in knowledge as to how BCRL microsurgical and conservative interventions complement each other. Furthermore, peri-operative outcome measures were inconsistent. Peri-operative guidelines are needed to bridge the knowledge and care gap between lymphedema surgeons and therapists.

Determination of indications for early surgical treatment in patients with ruptured anterior communicating artery aneurysms

Aim. To analyze and determine the optimal indications for microsurgical operative interventions in the shortest possible time from the subarachnoid hemorrhage onset to prevent anterior communicating artery (AcomA) aneurysm re-rupture and bleeding. Materials and methods. 280 patients with brain aneurysms were examined at the Uzhhorod Regional Center of Neurosurgery and Neurology and the City Hospital of Urgent and Emergency Medical Care under Zaporizhzhia City Council. Among them, 98 patients (48 males and 50 females) were diagnosed with AcomA aneurysms. The age of patients with AcomA aneurysms was from 20 to 72 years (mean age 47.8 ± 11.0 years). Aneurysms were verified using head and neck computed tomography angiography (a Toshiba Astelion scanner, 2016, No. 4СС162106), selective cerebral angiography (an angiography system General Energy Optima IGS 330, 2019, No. 80071260314), and brain magnetic resonance angiography (an i_Open 0,36 T magnetic resonance tomograph, 2005, No. Toc102633006). Cerebral hemodynamics was assessed using transcranial dopplerography (“Philips HD7” ultrasound diagnostic system, 2014, No. 69935). Results. In the first three days after the onset of subarachnoid hemorrhage, 18 (18 %) patients were admitted with ruptured aneurysms of this location, 62 (62 %) within 4–8 days, 12 (12 %) patients within 9–14 days, later than 14 days – 6 (6 %). All 98 patients underwent microsurgical clipping of AcomA aneurysms. Due to severe cerebral edema, decompressive craniectomy was performed in two patients. The results of surgical treatment were evaluated according to the modified Rankin scale at the time of hospital discharge and were as follows: in 65 (65 %) patients – good; in 18 (18 %) – moderate disability; in 4 (4 %) – serious disability. 11 (11 %) patients died. Conclusions. The treatment outcomes in patients with ruptured AcomA aneurysms were significantly dependent on factors related to increased risk of re-rupture: the presence of large-sized intracerebral hematoma, the aneurysm index exceeding 2, and multi-chamber aneurysm.

137. Comparison of Patient Outcomes and Efficiency of Microsurgeries Performed by Single Surgeon versus Co-surgeon

INTRODUCTION: As we search for strategies to optimize operating room turnover rate, allocation of human and financial resources, and patient outcomes, surgeons may stand to benefit from co-operating with another surgeon for long and costly procedures. In Microsurgical Reconstruction literature, there has been increased attention to comparing outcomes of surgeries that used a two-surgeon approach compared to a one-surgeon approach in regards to operative times, complication rate, and so on. We today meta-analyze the outcome measures of microsurgeries performed by co-surgeons compared to single surgeons. PURPOSE: To demonstrate superior operative time, length of admission, complication rate, flap loss rate, and return to OR of microsurgeries performed by dual-surgeons versus single surgeons. METHODS: A medical librarian (LHY) searched the literature for records including concepts for dual surgeons and surgical benefits. We created search strategies using keywords and controlled vocabulary to search in databases including Embase, Ovid Medlin, Scopus, The Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Trials, and Clinicaltrials.gov. Search strategies were completed April 29, 2020 resulting in 3,035 unique citations total. Three independent reviewers reviewed the literature and included 9 studies in microsurgery to identify the following data points: publication year, country, study design, type of surgical intervention performed, number of patients in the single-surgeon group, number of patients in the co-surgeon group, operative time (OT), length of stay (LOS), post-operative complications (POC), flap loss rate (FLR), and return to OR (LOR). If no standard deviation was provided, it was calculated based on published raw data. Literature that did not compare outcomes of single-surgeon to co-surgeon, or did not investigate microsurgical interventions, were excluded. A final revision for the correct data input was performed by a single reviewer, who ran statistical analysis. Meta-analysis and forest plots were created using RevMan Version 5. RESULTS: For each dependent variable, up to 7 papers qualified for inclusion. Results showed on average, Co-surgeon procedures were 50.0 minutes shorter than single surgeon procedures(95% CI: [-79.26, -20.67]). LOS was 0.46 days shorter for patients treated by co-surgeons (95% CI: [-0.81, -0.12],). For POC, the odds ratio for patients in co-surgeon group for having complications was 0.51 (95% CI [0.34, 0.75]). There was a tendency toward a lower FLR for patients in the co-surgeon groups (OR=0.48 [0.18, 1.30], p=0.15). Similarly, there was a trend toward fewer RTO in the co-surgeon group (OR=0.60 [0.35, 1.02], p=0.06). CONCLUSION: In the healthcare environment, where resources are at time scarce, multidisciplinary team approach might yield better outcomes. The dual-surgeon approach for microsurgical intervention decreases OT, LOS, POC, FLR, and RTO. This team structure decreases morbidity and improves healthcare resource utilization. The current literature demonstrates that patients, surgical teams, and the healthcare system at large stand to benefit when there are two-surgeons at the operative table. Institutional support for this team structure should be prioritized in centers where microsurgery is performed.

Clinical manifestation, course and treatment results of Coats disease in children

Purpose: to analyze the clinical manifestations, course, and results of treatment of Coats disease in children. Materials and methods. We performed a retrospective analysis of medical records of 59 patients with Coats retinitis (83 % were boys) who had been comprehensively examined and treated between 2018 and 2021. After the diagnosis was verified, the children were hospitalized for treatment. Retinal laser coagulation was performed on 61 eyes, angiogenesis inhibitors were administered on 1 eye, and 5 eyes received microsurgical interventions. Results. At the time of disease detection, the children’s age varied from 1 to 16 years. In 97 % of cases, the process was unilateral. An improvement of the anatomical condition and the eye-preserving effect were achieved in 87 %. Visual acuity could only be increased in 19 eyes (31.1 %), all with the initial or the advanced stages of Coats retinitis. Proceeding from our experience, the analysis of polymorphism of clinical manifestations, functional prognosis and differentiated approach to treatment depending on the prevailing clinical symptoms, we suggest a new variant of clinical classification of Coats retinitis. Conclusion. In order to ensure a timely diagnosis of the disease, a very thorough examination of patients in the first decade of life is required. Only an early diagnosis and timely treatment can help achieve not only an eye-preserving effect but also functional results.

A complex approach to the treatment of arteriovenous IV-V degree malformations according to Spetzler‒Martin scale. Clinical case

Four therapeutic approaches have been developed for the treatment of arteriovenous malformations (AVMs): microsurgery, radiosurgery, embolization, and conservative treatment. The lack of consensus regarding the choice of treatment method and the different specializations of the doctor who are onvolved to the patient with AVM often determine the wrong treatment strategy. We performed a prospective analysis of the results of AVM of the IV degree according to Spetzler‒Martin scale, 4–5 points on the Buffalo scale complex treatment, based on clinical and tomographic data after the use of partial endovascular embolization and radical microsurgical removal of the AVM node assisted by cell saving technology. According to cerebral angiography 4 months follow-up there is no visible AVM vessels, the malformation was completely resected.Treatment of large and giant AVMs (IV and V degrees according to the Spetzler‒Martin scale) requires tailored surgical treatment approache using endovascular, microsurgical and radiosurgical techniques, but in many cases without achieving a radical result. The use of cell saver technology is necessary to reduce the risks of intraoperative complications associated with blood loss during microsurgical intervention, and enables radical removal of the AVM and recovery of the patient. The role of cell saver technology is crucial in vascular microsurgical interventions, which are often accompanied by a significant volume of blood loss, ensuring rapid autologous hemotransfusion and restoration of circulating blood volume. Endovascular embolization is a necessary step to reduce the risks of intraoperative complications during microsurgical intervention, which, together with the use of cell saver technology, makes it possible to achieve radical AVM removal and patient recovery.

Traumatic intracranial aneurysms following combat damage

To develop the principles for the treatment of traumatic intracranial aneurysms after combat damage to skull and brain. There were 18 patients with traumatic intracranial aneurysms from February 2022 to the present. Of these, 15 ones had gunshot penetrating wounds of the skull and brain. In 3 cases, aneurysms developed after explosive injury. All patients underwent computed tomography (CT) of the brain, CT angiography of brain vessels and selective cerebral angiography. We analyzed nature of brain damage, trajectory of the wounding projectile and aneurysm location to determine predictors of traumatic intracranial aneurysms. Surgical treatment was performed in all cases. Hemorrhagic manifestations were observed in 11 patients. In 4 cases, traumatic intracranial aneurysms were diagnosed before rupture. Blunt head injury was followed by subarachnoid hemorrhage in 2 cases and ischemic stroke in 1 case. Endovascular or microsurgical intervention was performed depending on location of aneurysm, clinical manifestations and severity of brain damage. In case of distal aneurysms, endovascular and microsurgical destructive interventions prevailed. At the same time, proximal aneurysms (within or below the circle of Willis) required reconstructive endovascular treatment. Traumatic aneurysms should be suspected in all patients with penetrating craniocerebral injuries. Follow-up is contraindicated for traumatic intracranial aneurysms due to high risk of hemorrhage.

Lab partners: oocytes, embryos and company. A personal view on aspects of oocyte maturation and the development of monozygotic twins.

The present review addresses the oocyte and the preimplantation embryo, and is intended to highlight the underlying principle of the "nature versus/and nurture" question. Given the diversity in mammalian oocyte maturation, this review will not be comprehensive but instead will focus on the porcine oocyte. Historically, oogenesis was seen as the development of a passive cell nursed and determined by its somatic compartment. Currently, the advanced analysis of the cross-talk between the maternal environment and the oocyte shows a more balanced relationship: Granulosa cells nurse the oocyte, whereas the latter secretes diffusible factors that regulate proliferation and differentiation of the granulosa cells. Signal molecules of the granulosa cells either prevent the precocious initiation of meiotic maturation or enable oocyte maturation following hormonal stimulation. A similar question emerges in research on monozygotic twins or multiples: In Greek and medieval times, twins were not seen as the result of the common course of nature but were classified as faults. This seems still valid today for the rare and until now mainly unknown genesis of facultative monozygotic twins in mammals. Monozygotic twins are unique subjects for studies of the conceptus-maternal dialogue, the intra-pair similarity and dissimilarity, and the elucidation of the interplay between nature and nurture. In the course of in vivo collections of preimplantation sheep embryos and experiments on embryo splitting and other microsurgical interventions we recorded observations on double blastocysts within a single zona pellucida, double inner cell masses in zona-enclosed blastocysts and double germinal discs in elongating embryos. On the basis of these observations we add some pieces to the puzzle of the post-zygotic genesis of monozygotic twins and on maternal influences on the developing conceptus.

Mistakes in the Organization of Specialized Care for Patients with Traumatic Amputation of Hand Segments

The aim of the study appears to focus on identifying and analyzing errors or inadequacies within the organization of specialized care for patients who have experienced traumatic amputation of hand segments. The specific goals might include understanding the flaws in the existing care structures, improving patient outcomes, and developing recommendations to enhance the quality of specialized care provided to patients who have suffered hand segment amputations.Methods. 2020 to 2022 to the clinic of the National Scientific Center for Surgery named after Syzganov, 165 patients with acute injuries of limb segments were urgently hospitalized to provide specialized surgical care, leading to decompensation of blood circulation in the hand or fingers. Results. Due to incorrect actions in 24 patients, it was not possible to replant the delivered segments (33 segments). These patients underwent stump formation.At the same time, 50-75% still allow diagnostic, technical and tactical errors in the treatment of this category of patients. The possibility of replantation and revascularization, as well as their outcome, largely depended on the timeliness and quality of first aid, compliance with the conditions for preserving the cut-off segment, the speed of transportation and other organizational factors. Conclusions. The use of modern methods of microsurgical restorative interventions with the reconstruction of injured vessels can significantly expand the possibilities of preserving and restoring completely and partially torn segments of the hand and fingers. The improvement of the results of treatment of patients with traumatic amputations and injuries of the neurovascular bundles of limb segments was significantly affected by the provision of timely specialized microsurgical care

Inexpensive Materials for Microsurgery in Middle- and Low-Income Countries.

With the continuous incorporation of new technologies and advancements in surgical technique, microsurgical procedures around the world have generated a higher success rate and innovative procedures are now possible. In this setting, limitations regarding accessibility and acquisition of medical resources and equipment for these types of operations may be difficult in developing countries. We believe the dexterities of surgeons go beyond the surgical technique, meaning that we are able to use everyday materials to re-create affordable solutions that can be used during surgery in a safe way. This manuscript presents our experience with different surgical instruments and gadgets, developed out of necessity, to improve microsurgical interventions in developing countries.

Power-assisted Liposuction for Lymphedema: A Cost-utility Analysis.

Extremity volumes from all patients who underwent debulking surgery of the upper extremity at two institutions between December 2017 and January 2020 with at least 12 months follow-up were included. Procedural costs were calculated using Medicare reimbursement data. Average utility scores were obtained for each health state using a visual analog scale, then converted to quality-adjusted life years. A decision tree was generated, and incremental cost-utility ratios were calculated. Sensitivity analyses were performed to evaluate our findings. Debulking surgery is associated with a higher clinical effectiveness (quality-adjusted life year) of 27.05 compared to conservative management (23.34), with a relative cost reduction of $74,487. Rollback analysis favored debulking surgery as the cost-effective option compared to conservative management. The resulting negative incremental cost-utility ratio of -20,115.07 favored debulking surgery and indicated a dominant strategy. Our study supports the use of debulking surgery for the treatment of chronic lymphedema of the upper extremity.

Imaging methods for seminal tract obstruction

Differential diagnosis between obstructive and non-obstructive azoospermia is an important task in clinical management of infertile patients. Chances of extracting sperm in obstructive azoospermia are high enough to inform the couple about favorable outcome of assisted reproductive technologies without resorting to donor sperm. Some forms of seminal tract obstruction can be corrected by microsurgical interventions or endoscopic resection of the ejaculatory ducts. Therefore, one of the objectives standing before imaging methods in reproductive andrology is the detection of these cases. In this literature review we present a detailed analysis of how to suspect and diagnose this form of azoospermia using imaging.

Optical Technologies, Digitally Assisted: Surgical Microscope - quo vadis?

Adequate magnification and proper illumination are crucial for success in microsurgical interventions. Thus, surgical microscopes have long been an integral part of modern eye surgery and are at the heart of modern operating theatres. This paper first briefly reviews the history microscopes in ophthalmic surgery - from the initial developments in the mid 19th century to the current state of the art systems with powerful coaxial illumination and fibre-guided xenon or LED light sources. The discussion then turns to current developments, particularly in the area of workflow support and integration of complementary technologies such as intraoperative OCT, "augmented reality", and visual data feeds useful to the surgeon. The last part presents an outlook on future developments, with a particular focus on the digital image chain and intelligent automated assistance.