Cleft Lip and Palate Repair Using a Surgical Microscope

Abstract

BackgroundCleft lip and palate repair requires a deep and small surgical field and is usually performed by surgeons wearing surgical loupes. Surgeons with loupes can obtain a wider surgical view, although headlights are required for the deepest procedures. Surgical microscopes offer comfort and a clear and magnification-adjustable surgical site that can be shared with the whole team, including observers, and easily recorded to further the education of junior surgeons. Magnification adjustments are convenient for precise procedures such as muscle dissection of the soft palate.MethodsWe performed a comparative investigation of 18 cleft operations that utilized either surgical loupes or microscopy. Paper-based questionnaires were completed by staff nurses to evaluate what went well and what could be improved in each procedure. The operating time, complication rate, and scores of the questionnaire responses were statistically analyzed.ResultsThe operating time when microscopy was used was not significantly longer than when surgical loupes were utilized. The surgical field was clearly shared with surgical assistants, nurses, anesthesiologists, and students via microscope-linked monitors. Passing surgical equipment was easier when sharing the surgical view, and preoperative microscope preparation did not interfere with the duties of the staff nurses.ConclusionsSurgical microscopy was demonstrated to be useful during cleft operations.

Comprehensive review of surgical microscopes: technology development and medical applications

“… 116 Multiple optical ports are open for adaptation of imaging devices such as video cameras or for assistants to share the identical FOV. 25 , 117 …”

“…In some procedures, meaningful assistance has to be given by a cosurgeon sharing the same view with surgical microscope. 25 , 117 , 190 It aids not only assistance but also teaching and participation of trainees. 25 The simplest way to share the identical surgical view is to use an optical splitter to split the light into two eyepieces.…”

“…Some models have integrated HD cameras and monitors so the whole team can share the view on the screen. 19 , 25 , 117 , 191 …”

“… 85 Besides, other features including the share of view with assistant and staff team, recording, and position of comfort can also facilitate a smooth surgical workflow. 117 , 494 In this section, we will discuss several applications of the surgical microscope in plastic and reconstructive surgeries, including craniofacial surgery, reconstructive microsurgery, and dental plastic surgery.…”

No Longer a Pain in the Neck: Use of Operating Microscope for Palatoplasty

“… 8 Kato et al also demonstrated advantages using the microscope during palatoplasty, with a significantly improved instrument handling and surgical site visualization when using the microscope. 9 In addition to these reasons, we believe that the improved optics also allows for a better teaching environment, notably the variable zoom, advantageous focal length of an operating microscope being between 450 mm and 600 mm, whereas loupes are usually <400 mm, and ability to capture photographs and record videos. Newer microscopes are being utilized that have 3D viewing in 4K that enhance the experience even more.…”