Optical Magnification Should Be Mandatory for Microsurgery: Scientific Basis and Clinical Data Contributing to Quality Assurance

Background Microsurgical techniques are considered standard procedures in reconstructivesurgery. Although microsurgery by itself is defined as surgery aided by optical magnification,there are no guidelines for determining in which clinical situations a microscope or loupeshould be used. Therefore, we conducted standardized experiments to objectively assess theimpact of optical magnification in microsurgery.Methods Sixteen participants of microsurgical training courses had to complete 2 sets ofexperiments. Each set had to be performed with an unaided eye, surgical loupes, and a regularoperating microscope. The first set of experiments included coaptation of a chicken femoralnerve, and the second set consisted of anastomosing porcine coronary arteries. Evaluationof the sutured nerves and vessels were performed by 2 experienced microsurgeons using anoperating microscope.Results The 16 participants of the study completed all of the experiments. The nerve coaptationand vascular anastomoses exercises showed a direct relationship of error frequency and loweroptical magnification, meaning that the highest number of microsurgical errors occurred withthe unaided eye. For nerve coaptation, there was a strong relationship (P<0.05) between thenumber of mistakes and magnification, and this relationship was very strong (P<0.01) forvascular anastomoses.Conclusions We were able to prove that microsurgical success is directly related to opticalmagnification. The human eye’s ability to discriminate potentially important anatomicalstructures is limited, which might be detrimental for clinical results. Although not legallymandatory, surgeries such as reparative surgery after hand trauma should be conducted withmagnifying devices for achieving optimal patient outcomes.