Loupes‐only microsurgery

Abstract

Standard magnification in microsurgery is accomplished with the operating microscope. Loupes are perceived by the microsurgical community as technically less safe. However, after several years of microscope-only microsurgery, most of our microvascular procedures are performed under loupes 3.5-4x. Considering our results using loupes-only microsurgery, which are comparable with those obtained when using the microscope, we suggest that loupe-aided microsurgery might represent a natural progression for the experienced microsurgeon. Microsurgical skills and experience outweigh the importance of the magnification factor. While the microscope is mandatory for replantations distal to the palmary arch, microneurosurgery, and supramicrosurgery, loupes should be used in so-called "macro-microsurgery." One may include in this category replantations down to the palmar arch and free flaps with vessels more than 1.5 mm, such as the latissimus, serratus, (para)scapular, fibula, radial forearm, rectus abdominis, dorsalis pedis, omentum, and jejunum. Before starting loupes-only microsurgery, intensive training under the microscope is crucial. Less magnification does not mean less quality.

The Role of Posture, Magnification, and Grip Force on Microscopic Accuracy

“…Microsurgical skills and experience outweigh the importance of the magnification factor''. 20 Not all research supports this view, however. A study quantitatively investigating precision of an orthosis task using 93.5-4.0 loupe magnification and 98-30 microscope magnification concluded that the mean accuracy was higher to a statistically significant degree in the group using the higher magnification microscopes.…”

Review of microsurgery and arteriovenous fistulae for hemodialysis

“…Pieptu and Luchian stated that microsurgical techniques should be used for the creation of AVFs, irrespective of the level of the anastomosis. 29 Margic supported the use of microsurgical techniques in the creation of AVFs because of the effects of ESRD on the vasculature. 30 Pieptu and Luchian recommended wide-field loupes as the first choice for most anatomoses, but suggested the use of a microscope for thinwalled vessels or diseased vasculature.…”

“…30 Pieptu and Luchian recommended wide-field loupes as the first choice for most anatomoses, but suggested the use of a microscope for thinwalled vessels or diseased vasculature. 29 Bourquelot et al reported that with the use of a microscope, the vascular dissection and creation of anastomoses are made easier. 6 The microscope and the use of preventative hemostasis, such as with an inflatable tourniquet, allow the creation of AVFs even in children under 5 kg in weight.…”

The Use of Surgical Loupes in Microsurgery

“…With respect to their favorable outcomes, while using surgical loupes in "macro-microsurgery," Pieptu and Luchian acknowledged the ability to use loupes while performing replantations proximal to the palmar arch and in free flaps with vessel diameter greater than 1.5 mm. 3 In summary, while the literature lacks studies allowing strong evidence-based recommendations, several key points can be drawn: 1. Technical skill and experience developed using the surgical microscope is necessary before loupeassisted microsurgery. 2.…”