Microsurgical Techniques Research Articles

Developmental History of Microvascular Decompression Surgery for Cranial Nerve Dysfunction

Trigeminal neuralgia is characterized by severe lancinating pain in the face and hemifacial spasms displayed by continuous facial muscle twitching, which may impair a patient's quality of life. Before 1960, in the United States of America, the treatment of such symptoms was only partial rhizotomy of the cranial nerves, which resulted in postoperative complications.1, 2) Afterwards, in the late 1960s, it became evident that the etiology of symptoms was an elicited arterial compression of the cranial nerves at the "Root Entry/Exit zone." Microvascular decompression(MVD)was introduced and finally became largely popularized by Gardner and Jannetta et al.3, 4) In 1978, at the Neurosurgical Meeting in New York, I incidentally witnessed slides of MVD proposed by Jannetta, which gave me a big surprise since we were then treating such patients by old-fashioned rhizotomy. Despite much ignorance displayed even in the neurosurgical meeting, I started MVD in 1980.5) In addition, in 1998 we held an Annual Meeting of the Japan Society for Microvascular Decompression Surgery, which has become more active in the fields of microsurgical techniques, diagnosis, monitoring, and long-term follow-up studies.6-8) MVD is a functional neurosurgery and satisfactory results should entail a complete and permanent cure of symptoms without any postoperative sequelae. This makes MVD a sustainable surgery.

History of surgical treatment of lymphatic drainage at the Department of Plastic and Aesthetic Surgery, St. Anne's University Hospital in Brno.

The Department of Plastic and Aesthetic Surgery, St. Anne's University Hospital in Brno, and Faculty of Medicine of Masaryk University, Brno, has a long history of surgical treatment of lymphedema and elephantiasis, which started in 1970s. There were many types of surgeries described and performed at our department - starting with prof. Bařinka's radical operation of elephantiasis, then lower limb end-to-side lymphovenous anastomosis pulled through the wall to the great saphenous vein, and genital lymphedema reduction. We call this era "the first period" of surgical lymphedema treatment. "The second period" started in 2016 by using free flaps with lymph nodes or vascularized lymph nodes and using microsurgical techniques of end-to-end, end-to-side and side-to-end lymphovenous anastomoses to the subcutaneous veins of a small calibre, which then drain the lymph into the blood stream. "The third period" started 2 years ago after the visit of prof. Yang from Taiwan - we started to use the method of single stitch end-to-side anastomosis to big subcutaneous veins like the great saphenous vein or the cephalic vein.

Uloga šake i nastanak invalidnosti kao posledice povrede na radu

The paper describes a patient who sustained an injury while working as a bookbinder, resulting in the replantation of the second, third and fourth fingers and the re-amputation of the thumb and fifth finger of the left hand, as well as skin grafting for the distal phalanges of the third and fourth fingers of the right hand. At the time of the injury, the patient was on probation with the employer and did not have the status of an insured person with the right to compulsory social insurance based on employment (employee). Due to this, the Injury Report was not completed, and the injury was not recognized as a workplace injury, which prevented the patient from obtaining their rights under compulsory social insurance. The human hand is one of the most powerful tools for achieving the sense of touch, gesticulation, and other various demands, thus playing an extremely important role in life. Thumb injuries can impair overall hand function by 40-50%. For this reason, there has been a need to develop modern technologies for reconstructing amputations over time. In the mid-20th century, microsurgical techniques for toe-to-thumb transfers gained clinical importance and remain one of the most significant approaches to thumb reconstruction. Due to the reduction in work and life activities and to facilitate employment, the patient was referred to the Pension and Disability Insurance Fund Commission at the National Employment Service to obtain the status of a person with a disability.

New Microsurgical Techniques for Refractory Vertebrobasilar Insufficiency Addressing V1 Segment of Vertebral Artery’s External Compressions and Dolichoarteriopathies

New Microsurgical Techniques for Refractory Vertebrobasilar Insufficiency Addressing V1 Segment of Vertebral Artery’s External Compressions and Dolichoarteriopathies

Surgical Innovation: Advanced Strategies in the Treatment of Pathologies in the Oropharynx and Parapharyngeal Space

Transoral surgery has evolved and its indications for treating diseases of different regions of the head and neck have increased. Pathologies that affect different sectors of the oropharynx and parapharyngeal space can be treated in selected patients through a transoral approach, significantly reducing the morbidity of surgery and the adjuvant treatments. Objectives: To determine the effectiveness of transoral surgery of the oropharynx and parapharyngeal space in patients treated with transoral surgery with microscope (TOMS) for tumors and other pathologies. Methods: Patients treated via transoral approach with the assistance of endoscopes or using a microscope for benign or malignant tumors, as well as other pathologies affecting different regions of the oropharynx (tonsillar fossa, tongue base, and pharyngeal walls) and the parapharyngeal space, between March 2004 and April 2022, were included in the study. To perform the surgeries, cautery, ultrasonic scalpel and CO2 laser were used. Results: Twenty patients with different lesions affecting various regions of the oropharynx and parapharyngeal space were treated using a transoral approach. Ten patients underwent surgery for lesions located at the base of the tongue, two were treated for tumors located in the tonsillar fossa, four patients had lesions located in the posterior and lateral walls of the oropharynx and four patients had lesions located in the parapharyngeal space. Conclusions: Transoral surgery of the oropharynx and parapharyngeal space assisted with endoscopes was highly effective, allowing adequate exposure and complete resection of various benign and malignant tumors, as well as the resolution of other diseases treated using this approach. There was no need to convert the transoral approach to an open procedure. The use of microsurgical technique was infrequent, and we found it to be more suitable for small tumors at the base of the tongue or lesions located in the lower sector of the posterior pharyngeal wall.

Effect of the extent of posterior septectomy on surgical access during the endoscopic endonasal approach to the sella: A technical note

BackgroundUsing the bi-nostril 4-hand technique during the endoscopic endonasal approach (EEA) facilitates bimanual microsurgical techniques yet requires resection of the posterior nasal septum. The surgical exposure and degree of maneuverability gained proportionate to the extent of posterior septectomy in the sagittal plane was previously quantified. Research questionWe aim to describe our technique of posterior septectomy, and the effect of its extent in the axial plane on surgical access, and instrument maneuverability. Material and methodsAfter fracturing the posterosuperior nasal septum, we disarticulate the vomer from the sphenoid rostrum and remove its upper part. The sphenoid rostrum is excised next exposing the clival recess where a suction tip without a side channel is anchored, allowing the assisting surgeon to use an additional instrument in their dominant hand. The vomer is removed down to the level of the floor of the sphenoid sinus. ResultsA wide exposure is achieved in the coronal plane bilaterally at the level of the sphenoid rostrum allowing unobstructed instrument manipulation in the craniocaudal and cross-court trajectories. Furthermore, the floor of the sella is reached through a straight rather than angled trajectory facilitating surgical access, manipulation, and instrument maneuverability. For lateral lesions requiring contralateral access, the assisting surgeon can assist in dissection from the contralateral nostril without changing the position of the endoscope. Discussion and conclusionRemoving the upper vomer improves surgical access, and instrument maneuverability. Simultaneous dissection from both nostrils might be attempted. Caudally extending the posterior septectomy during the EEA allows better exposure and improves surgical access in all planes.

Comment on The Transition to Microsurgical Technique for Hepatic Artery Reconstruction in Pediatric Liver Transplantation

Comment on The Transition to Microsurgical Technique for Hepatic Artery Reconstruction in Pediatric Liver Transplantation

Quantitative Anatomical Study of the Supratentorial and Infratentorial “Endoscopic Keyhole” Approach to the Peripineal Region

Background. The pineal region represents significant challenges in terms of neurosurgery. Currently, anatomical research that simulates surgery for the endoscopic keyhole approach to the pineal region is lacking. This study aims to summarize the exposure range and operational characteristics of total endoscopic surgery under the four supratentorial and infratentorial keyhole approaches, through rigorous quantitative anatomical research. We also aim to understand the surgical exposure characteristics and surgical feasibility under each approach. Method. Six wet cadaveric head specimens (a total of 12 sides) were subjected to simulated surgery with a keyhole bone window size of approximately 3 × 4 cm. The median endoscopic supracerebellar infratentorial approach (M‐ESCITA), the paramedian endoscopic supracerebellar infratentorial approach (PM‐ESCITA), the endoscopic occipital transtentorial approach (EOTA), and the endoscopic interhemispheric high occipital transtentorial approach (EHOTA) were used to measure the surgical path depth, maximum distance between the tentorial margins, maximum operable area, operable angle, and relative degree of freedom of each approach. Results. There was no difference in the exposure range of the surgical area. The surgical path of PM‐ESCITA was the longest (p < 0.001), and its horizontal operating angle was the largest (p < 0.001), whereas the anteroposterior operating angle of EHOTA was the largest (p < 0.001). The maximum operational area of M‐ESCITA was the largest in the pineal region (p < 0.01), whereas that of EHOTA was the largest in the tetrapod region (p < 0.001). M‐ESCITA had the highest relative degree of freedom during surgery at the pineal gland level (p < 0.001), PM‐ESCITA at the splenium of the corpus callosum (p < 0.01), and EHOTA at the corpora quadrigemina (p < 0.001). Conclusions. Each of the four endoscopic keyhole approaches has its own advantages. Through anatomical research, doctors can train themselves and master the differences in surgical procedures through different approaches. The choice of approach and surgical challenge are dependent on the microsurgical techniques employed by the surgeon. A balance between minimally invasive and safe endoscopic surgery should be pursued.

A clinical case of successful surgical treatment of a posttraumatic false aneurysm of the ulnar artery as a manifestation of hypothenar hammer syndrome in a young patient

We present a case of a successful surgical treatment of posttraumatic false aneurysm of the left ulnar artery in a young patient with hypothenar hammer syndrome (HHS). Patient I., 22 years old, was admitted to the Clinic of Vascular Surgery with complaints of a throbbing painful mass on the palmar surface of the left hand. The patient was known to have a posttraumatic thrombophlebitis of the trunk and tributaries of the great saphenous vein of the right shin with incomplete recanalization of the lumen of unknown age and also he suffers from varicose veins of both lower limbs. The diagnoses were confirmed by ultrasound examination. The patient was examined and the results revealed an aneurysmal dilatation of the left ulnar artery in the wrist with a maximal diameter of 6.5 mm, the indication for surgical treatment were determined. On February 09, 2023, a surgical intervention was performed: aneurysm resection followed by ulnar artery replacement with a reversed аutologous vein. The clinical interest of the observation lies in the rare occurrence of this syndrome among patients, technical complexity of the operation due to anatomical features of the aneurysm location, as well as the use of microsurgical techniques during surgical treatment. The use of angiographic control made it possible to timely eliminate the pronounced vasospasm that developed immediately after starting the blood flow through the reconstructed section of the arterial bed. The result of the intervention was a complete relief of pain and pulsation in the left hand in the early postoperative period.

Size adjustment suture technique for lymphaticovenular anastomosis.

In this report, we describe a super microsurgical technique that enables rapid and accurate anastomosis while adjusting for caliber differences when anastomosing a small-caliber lymphatic vessel and a vein with a larger caliber, which is frequently encountered in surgeries such as lymphaticovenous anastomosis (LVA). The suture size adjustment technique was performed in 30 anastomoses of lymphatic vessels and veins, whose diameter of lymph duct was at least two times smaller than that of the vein. The type of lymphedema, caliber of lymphatic vessels and veins anastomosed, caliber ratio, vein wall thickness, modified caliber ratio after vein wall thickness subtracted, presence of additional anastomosis, and anastomosis time were examined. On average, the lymphatic vessels had a diameter of 0.61 mm, while the veins were 1.43mm in diameter. The mean caliber ratio of vein to lymphatic vessel was 2.3, while the modified caliber ratio of vein-to-lymphatic vessel was 1.5 on average. The average venous wall thickness was 0.51. The average anastomosis time was 9.1min and no additional anastomosis due to leakage was necessary in any case. We successfully performed an anastomosis of lymphatic vessels and veins with different calibers, which can maintain long-term patency while adjusting the caliber difference and suppressing leakage at the anastomosis site. Finally, the caliber of the vein is commonly larger than that of the lymphatic vessel to be anastomosed in many cases of LVA surgery, indicating that the proposed anastomosis method could be of therapeutic use in many cases.

A retrospective cohort study of robotic‐assisted laparoscopic radical prostatectomy (RARP) to PONV scale effects on Alzheimer’s Disease‐Related Dementia patients’ sleep and vitality risks

AbstractBackgroundProstate cancer is the most commonly safe with minimal morbidity and mortality rates of tumor cancer using microsurgical techniques. However, these rates have risen rapidly in the past two decades. This study aimed to determine comparing microsurgical prostatectomy techniques in National Comprehensive Cancer Network (NCCN) high‐risk and low‐risk robot‐assisted laparoscopic radical prostatectomy (RARP) and conventional laparoscopic radical prostatectomy (LRP) approach.MethodsRetrospective case observation study of single team laparoscopic and robotic‐assisted laparoscopic radical prostatectomy for NCCN (n = 855,893) high‐risk and low‐risk prostate cancer from 2009 to 2020. 307 Alzheimer’s Disease and Alzheimer’s Disease‐related Dementias patients were divided into two groups, 120 patients low‐risk and 187 patients high‐risk, undergoing radical prostatectomy for prostate cancer using LRP and RARP. To determine univariate and adjusted odds and hazard ratios for BCR, post‐operative detective, and post‐salvage therapy disease between low‐risk and high‐risk groups in undetectable PSA patients.Results307 patients in the detectable NCCN group 120 patients for very high‐risk and 187 patients in high‐risk groups. Very high‐risk groups have significant differences compared with high‐risk groups by PSA density (p<0.001), BCR in undetectable PSA (p<0.001), PSA rate (p<0.004), and salvage therapy (p<0.001). Univariate hazard ratios for BCR and univariate odds ratios for post‐operative detective PSA, post‐salvage therapy disease, and time to BCR in very high‐risk groups have significant differences (p<0.001) compared with high risk.ConclusionsRARP has better effects than conventional LRP available regarding lower incidence and risk factors. Very high‐risk prostate cancer is not good for radical prostatectomy and selected high‐risk group.

A retrospective cohort study of robotic‐assisted laparoscopic radical prostatectomy (RARP) to PONV scale effects on Alzheimer’s Disease‐Related Dementia patients’ sleep and vitality risks

AbstractBackgroundProstate cancer is the most commonly safe with minimal morbidity and mortality rates of tumor cancer using microsurgical techniques. However, these rates have risen rapidly in the past two decades. This study aimed to determine comparing microsurgical prostatectomy techniques in National Comprehensive Cancer Network (NCCN) high‐risk and low‐risk robot‐assisted laparoscopic radical prostatectomy (RARP) and conventional laparoscopic radical prostatectomy (LRP) approach.MethodsRetrospective case observation study of single team laparoscopic and robotic‐assisted laparoscopic radical prostatectomy for NCCN (n = 855,893) high‐risk and low‐risk prostate cancer from 2009 to 2020. 307 Alzheimer’s Disease and Alzheimer’s Disease‐related Dementias patients were divided into two groups, 120 patients low‐risk and 187 patients high‐risk, undergoing radical prostatectomy for prostate cancer using LRP and RARP. To determine univariate and adjusted odds and hazard ratios for BCR, post‐operative detective, and post‐salvage therapy disease between low‐risk and high‐risk groups in undetectable PSA patients.Results307 patients in the detectable NCCN group 120 patients for very high‐risk and 187 patients in high‐risk groups. Very high‐risk groups have significant differences compared with high‐risk groups by PSA density (p<0.001), BCR in undetectable PSA (p<0.001), PSA rate (p<0.004), and salvage therapy (p<0.001). Univariate hazard ratios for BCR and univariate odds ratios for post‐operative detective PSA, post‐salvage therapy disease, and time to BCR in very high‐risk groups have significant differences (p<0.001) compared with high risk.ConclusionsRARP has better effects than conventional LRP available regarding lower incidence and risk factors. Very high‐risk prostate cancer is not good for radical prostatectomy and selected high‐risk group.

Surgery for Obstructive Azoospermia

Microsurgical technique in male infertility has progressed significantly since the introduction of intracytoplasmic sperm infection (ICSI) 30 years ago. The searching of sperm available for ICSI becomes the main tasks for reproductive andrologists. At the initial study for patients with azoospermia, it is crucial to differentiate obstructive causes from non-obstructive categories. Testis biopsy is still a gold standard testing method to confirm obstructive azoospermia (OA). For patients with OA, the choice spectrum of treatment is broad. Basically, sperm can be retrieved from anywhere upstream the blocking spot along the male reproductive tract. However, it is not always that infertile couples consider ICSI as their treatment of choice. The choice of treatment should be prioritized according to patients’ concerns. The concerns include age of female partner, the patency of oviducts, the presence of infection in the seminal plasma, DNA fragmentation index of sperm, failure of prior use of downstream sperm for in vitro fertilization (IVF) or ICSI, religious limitation, economical affordability, number of babies expected and techniques available from the surgeons. For techniques view, the surgeons should be equipped with capabilities of techniques for sperm retrieval from the testis (testicular sperm extraction, abbreviated TESE) and epididymis (percutaneous epididymal sperm extraction abb. PESA; or microscopic epididymal sperm aspiration abb. MESA). Besides, techniques of microsurgical anastomosis of vas (vasectomy reversal or vaso-vasostomy) and epididymal tubule (vaso-epididymostomy) after scrotal exploration are also required. Other special conditions of obstructive azoospermia are also included, such as congenital absence of vas deferens (CBAVD) or causes for dry ejaculation (including diabetes neuropathy, or post retroperitoneal surgery), or obstruction of ejaculatory ducts. Herein, I would like to share the experiences on treatment of various types of obstructive azoospermia, via scrotal exploration and the techniques of epididymovasostomy. Besides, different techniques of sperm retrieval like MESA and TESE are also demonstrated.

Lymphoedema surgery in Australia: a narrative review.

Lymphoedema is a chronic condition that affects millions of people worldwide. It is often caused by the damage or removal of lymph nodes during cancer treatment. One of the most effective management options for lymphoedema is surgery, which can reduce swelling and potentially improve lymphatic drainage. Throughout history, Australia has been at the forefront of research and development in this field. In this review, we aim to examine the contributions of Australian research to lymphoedema surgery. We conducted a search in the PubMed and Embase databases to identify Australian research relating to lymphoedema surgery from inception to the present day. Studies that met the inclusion criteria were reviewed and analysed, and the results were presented. After reviewing the literature, it was apparent that the field of lymphoedema surgery owes much to the contributions of Australian research. Early work from famous Australian surgeons such as Bernard O'Brien and Geoffrey Ian Taylor laid the bedrock for modern surgical techniques. Furthermore, more recently, Australia has seen a resurgence of clinical research contributing to the international evidence for lymphoedema surgery. Australia has made significant contributions to the field of lymphoedema surgery, particularly in the development of modern microsurgical techniques such as lymphovenous anastomosis or vascularised lymph node transfer. These contributions have led to improved patient outcomes and quality of life. Going forward, Australia will hopefully continue to be a leader in research and innovation in this field.

United States insurance coverage of immediate lymphatic reconstruction.

Immediate Lymphatic Reconstruction (ILR) is a prophylactic microsurgical lymphovenous bypass technique developed to prevent breast cancer related lymphedema (BCRL). We investigated current coverage policies for ILR among the top insurance providers in the United States and compared it to our institutional experience with obtaining coverage for ILR. The study analyzed the publicly available ILR coverage statements for American insurers with the largest market share and enrollment per state to assess coverage status. Institutional ILR coverage was retrospectively analyzed using deidentified claims data and categorizing denials based on payer reason codes. Of the 63 insurance companies queried, 42.9% did not have any publicly available policies regarding ILR coverage. Of the companies with a public policy, 75.0% deny coverage for ILR. In our institutional experience, $170,071.80 was charged for ILR and $166 118.99 (97.7%) was denied by insurance. Over half of America's major insurance providers currently deny coverage for ILR, which is consistent with our institutional experience. Randomized trials to evaluate the efficacy of ILR are underway and focus should be shifted towards sharing high level evidence to increase insurance coverage for BCRL prevention.

The surgical management of frontal branch of the facial nerve injuries

Aim: The frontal branch of the facial nerve is particularly vulnerable to traumatic injury or during surgery. While the larger branches of the facial nerve, such as the buccal branch, are more easily identifiable and amenable to repair, the repair of the frontal branch is not common due to its complex branching pattern and smaller size. The description of the surgical approach to repair the frontal branch of the facial nerve is limited in the literature. In this study, we aim to explore the outcomes of patients who underwent frontal branch facial nerve repair in our centre. Method: In a retrospective case review at a single, tertiary Plastic Surgery centre, we performed frontal branch repair for eight patients (n = 8) who sustained complete or partial division of the frontal branch of the facial nerves. These patients were followed up postoperatively and assessed with the Sunnybrook Facial Grading System. Results: Using super microsurgical techniques, primary nerve coaptations, fascicular nerve flaps, and direct neurotisations were performed. All eight patients (100%) demonstrated improvements in terms of resting brow symmetry. There was a significant improvement in brow and frontalis function following surgical repair of the frontal branch, with 87.5% (seven patients) demonstrating improvement in forehead movement. Conclusion: In this case series, we demonstrated that the repair of the frontal branch of the facial nerve is relevant, with reasonably good functional outcomes. Repair of the frontal branch of the facial nerve should ideally be done as early as possible following the injury. Nevertheless, delayed repair may still be beneficial within 18 months after the injury.

Proposed operative approach in a critical area of the brain stem

Backgroundand Importance:The surgical approach to the medulla oblongata poses a significant challenge for neurosurgery, considering the clinical consequences and risks of this procedure. The authors describe a step-by-step technique to safely extirpate a cavernous malformation within the hypoglossal trigone with minimal risk of neurological deficits.Clinical Presentation: In a young 33-year-old patient was identified a lesion in the center of the medulla oblongata. Complete resection of the cavernous malformation through the hypoglossal trigone was performed with an improvement of all symptoms. The key surgical tip is to dissect the lesion between the posterior median sulcus and the sulcus limitans avoiding the vagal trigone. ConclusionSurgical approach through the hypoglossal trigone appears to be safe and effective for the treatment of medulla oblongata cavernomas. The entry zone through the dorsomedial sulcus of the hypoglossal trigone with a meticulous delicate microsurgical technique is the key to success with these kinds of lesions.

Simulation-Based Bypass Training and Learning Curves-Resident Experience.

Introduction Bypass surgery is a challenging operative procedure that requires surgical excellence. Achieving the skills required for vascular surgery is difficult to master in the operating room without intensive microsurgical training. Various models have been developed to provide training to young neurosurgeons and increase dexterity and patient safety. Bypass surgery requires complex microsurgical techniques. Methods Microanastomosis training was performed on plastic tubes and chicken wings for 2 months. Each microanastomosis was evaluated by a senior author. Results An improvement in the quality and patency of microanastomosis was observed. Conclusion Microsurgical simulation training can contribute to the improvement of surgical skills and dexterity.

A Microsurgical Arteriovenous Malformation Model on Saphenous Vessels in the Rat.

Arteriovenous malformation (AVM) is an anomaly of blood vessel formation. Numerous models have been established to understand the nature of AVM. These models have limitations in terms of the diameter of the vessels used and the impact on the circulatory system. Our goal was to establish an AVM model that does not cause prompt and significant hemodynamic and cardiac alterations but is feasible for follow-up of the AVM's progression. Sixteen female rats were randomly divided into sham-operated and AVM groups. In the AVM group, the saphenous vein and artery were interconnected using microsurgical techniques. The animals were followed up for 12 weeks. Anastomosis patency and the structural and hemodynamic changes of the heart were monitored. The hearts and vessels were histologically analyzed. During the follow-up period, shunts remained unobstructed. Systolic, diastolic, mean arterial pressure, and heart rate values slightly and non-significantly decreased in the AVM group. Echocardiogram results indicated minor systolic function impact, with slight and insignificant changes in aortic pressure and blood velocity, and minimal left ventricular wall enlargement. The small-caliber saphenous AVM model does not cause acute hemodynamic changes. Moderate but progressive alterations and venous dilatation confirmed AVM-like features. The model seems to be suitable for studying further the progression, enlargement, or destabilization of AVM.

Video-Based Assessment of Microsurgical Trainees: An Evaluation of Gender Bias.

Gender bias in graduate medical evaluations remains a challenging issue. This study evaluates implicit gender bias in video-based evaluations of microsurgical technique, which has not previously been described in the literature. Two videos were recorded of microsurgical anastomosis; the first was performed by a hand/microsurgery fellow and the second by an expert microsurgeon. A total of 150 surgeons with microsurgical experience were recruited to evaluate the videos; they were told these videos depicted a surgical trainee 1 month into fellowship followed by the same trainee 10 months later. The only variable was the name ("Rachel" or "David") that each participant was randomly assigned to evaluate. Participants were asked to score each video for quality, technique, efficiency, as well as overall progression and development after the second video compared with the initial video. To focus on bias, these outcome measures were selected to be purposefully subjective and all ratings were based on a subjective 1to 10 scale (10 = excellent). The analysis included 150 participants (75% male). There were no statistically significant differences in scores between the "female" and "male" trainee. The trainees received the same median initial (1-month video) and final (11th-month video) scores for all criteria except initial technique, in which the female trainee received a 7 and the male trainee received an 8. Notably, 11-month scores were consistently the same or lower than 1-month scores for both study groups (p < 0.001). There were also no differences within either study group based on participant sex. Microsurgery practitioners overall rated both groups lower than those who do not currently practice microsurgery. Our study did not identify a gender bias in this evaluation method. Further investigation into how we assess and grade trainees as well as the presence and impact of implicit biases on varying surgical assessment methods is warranted.