Chesapeake Bay Perioperative Consortium 2017 Microsurgery Chesapeake Bay Perioperative Consortium 2017

Objectives Identify components of an operative microscope Identify microsurgical instruments and instrument design features Describe microsurgical techniques Discuss the care of the microscope Discuss the surgical consideration of the handling of the microscope

Advantages of Microsurgery Restoration of wholeness of the body Advantages of Microsurgery

Microscope Components Optical lens system/lighting Mounting system Electrical system Accessory items/attachments

Optical Lens System Has 4 main components…. Objective Lens Ocular Lens Light Source Focusing

Lighting System Coaxial Most commonly used Transferred through a fiber optic cable Paraxial One or more light tubes Tungsten or halogen bulbs Must focus light on the field

Mounting System Wall mount (on a bracket) Floor mount Track mount (ceiling mount)

Accessories Assistant’s binoculars Microscope drape Camera/video adapter Laser micro-adapter Remote foot control Sliding stool/chair

Microscope Care Tighten all joint knobs before moving Keep body of scope close to mounting post while moving Install attachments over a bed or stretcher Keep covered with plastic to avoid damage during storage Cover foot pedal with plastic to avoid contact with blood or fluids Clean lenses with a soft, lint free cloth or paper designed for lens care

Additional Light Sources Fiber-optic headlight is used when the surgeon requires a highly intense light in a small area (ex. ear, nose or deep cavity) Magnifying loupes are worn much the same as eye glasses to increase the area in size.

Microsurgical Technique Dissection and repair of fine structures through better visualization Adaptation of surgical procedures from visual orientation to hands on orientation Less surgical trauma to tissue

Instrument Design Shape and tips Shorter/some angled for better visualization Handles Designed to conform to hand movements Material and surface Very vulnerable to abuse Titanium – strong/light Dull finish to reduce glare

Surgical Considerations Leave protective covers on instrument tips until ready for use Leave instruments in holders with tips in the air Avoid catching tips on towels or other linens Handle each instrument individually Gently wipe each instrument after each use with lint-free gauze or non-fibrous sponge Place instruments in order of use for smooth flow

Surgical Considerations cont. Place instrument in the physician’s hand in position of use Assist effectively, but never put hands in the surgical field unless requested to do so Do not touch microscope or lean against the OR bed Place foot pedal comfortably within physician’s reach Surgeon adjusts chair armrests, wrist-rest prior to scrubbing Adjust microscope prior to surgeon scrubbing, if possible

Instrument Care Clean and dry by hand No mechanical washing Use soft bristled brush Clean and dry by hand No mechanical washing Lubricate and sterilize according to manufacturer Use specialized trays/holders with tip protectors

References Fairchild, S.S. Perioperative Nursing: Principles and Practice, 2nd ed. Little Brown and Company, 1996 Rothrock, J.C. Alexander’s Care of the Patient in Surgery, 12th ed. Mosby, 2003