Use of loupes magnification and microsurgical technique in thyroid surgery: ten years experience in a single center.

AIM: The use of microsurgical technique and loupes magnification as a support to traditional surgery can help surgical performance and prevent complications in thyroid surgery. PATIENTS AND METHODS: Between January 2004 and December 2014, 782 patients with thyroid diseases were operated by our team with microsurgical technique and loupes magnification 4.5x. All patients had pre and postoperative vocal cords assessment and calcemia and the collected data were analysed. RESULTS: Among the 782 patients, only six patients (0.77%) had unilateral vocal fold immobility treated with medical therapy, phoniatric and neck physiotherapy. All six patients showed complete laryngeal recovery of motility 6/8 weeks after treatment. There were not cases of permanent monolateral or bilateral vocal cord palsy. In 84 patients there were signs and symptoms of hypocalcemia. In 81 patients (10.36%) the restoring of biochemical parameters and the resolution of symptoms occurred between 2 and 6 weeks and in 3 cases (0.38%) there was permanent hypocalcemia more than six months. CONCLUSION: The use of microsurgical technique and loupes magnification in thyroid surgery are safety and effective procedures, that require an appropriate training in reconstructive microsurgery, but may significantly reduce post-operative complications. Here, we report for the first time the largest series of thyroid surgery performed with the use of microsurgical technique and loupes magnification, analysing the postoperative morbidity. In view of our results, we suggest the routine use of 4.5X loupes and microsurgical technique in thyroid surgery.

Interposition vein cuff in infrainguinal prosthetic bypasses.

The Authors describe the interposition vein cuff technique as an adjuvant method to infrainguinal prosthetic bypass grafts. The haemodynamic, mechanical and humoral factors thought to be involved in the beneficial effects of the vein cuff are herein discussed. The results of the main series suggest the use of this method particularly in patients without any available autologous vein conduit requiring a below-knee popliteal or crural reconstruction.

[Cervical neurinomas. (Considerations in five cases operated in Day-Surgery)]. / I neurinomi cervicali. (Considerazioni su 5 casi operati in Day-Surgery).

We report the experiment of five cases of neurinoma observed in the division of Day Surgery of the Third Surgery Clinic, operating in the Hematology Institute of University of Studies "La Sapienza" in Rome. The problems of the diagnosis of this neoplasia has been faced, though it is commonly unknown or confused with other cervical especially lymphonodules tumefactions, from which it is almost impossible to distinguish before the operation. In the period of six years on 775 cases of cervical neoformations have been operated only 5 patients bearers of neuromi; two originated from vago cervicale (right and left), one from simpatico cervicale on the left, another from the left spinal accessory and the last from the secondary medial trunk of the left brachial plexus. All the patients have been operated in Day-Surgery anaesthesia, locoregional and with calming of spontaneous breath. One case, that originated from the secondary medial trunk of the left brachial plexus, has been operated with microsurgical technique. On all the cases has been done a subcapsular exeresis to preserve nervous continuity. No post operating complications have been recorded; all the patients discharged in the evening. The diagnosis about the nature is left to the final histological test on the operating piece. The surgical removal remains even today the elective treatment able to exclude probable relapses and potential malignant transformation of these tumours.

[Reconstructive microsurgery]. / La microchirurgia ricostruttiva.

Since Microsurgery was born, it has been employed in different surgical fields offering more recently good chances even in sterility. Furthermore microsurgical techniques offer a great support to Plastic Surgery. In fact, it is possible to repair wide tissue damages of the skin, muscles or bones using free flaps. The percentage of success of this surgery increased the overall rate of success of surgical procedures. Therefore a close multidisciplinary relation between the different fields is absolutely required for a correct application of microsurgical techniques.

[Posttraumatic pseudoaneurysms of the anterior tibial artery: a review of the literature and a clinical case report]. / Pseudoaneurismi post-traumatici dell'arteria tibiale anteriore: revisione della letteratura e presentazione di un caso clinico.

The authors after a review of the literature report a case of anterior tibial artery false aneurysm in a seventeen year old male, due to traumatic sprained ankle during a basketball match. Surgical techniques used in repairing the lesion as well as microsurgical technique for the direct suture of the artery, which allowed to resolve the problem, are discussed.

[Reconstructive microsurgery]. / Microchirurgia ricostruttiva.

Progress in microsurgery has been accomplished by the technical improvements of the operative microscope and other delicate surgical instruments. Therefore, even small arteries as well as female tuba and male deferens, either presenting mechanical obstruction or a section, can be reconstructed. The same procedure may be applied in case of nerve injuries. Since Microsurgery was born, it has been employed in different medical fields offering lately good chances in sterility. Furthermore, microsurgical techniques offer a great support to Plastic Surgery. In fact, it is possible to repair wide tissue damages of the skin, muscles or bones using free flaps. The percentage of success of this Surgery increased the overall percentage obtained in General Surgery. Therefore a close multidisciplinary relation between the different Medical fields is absolutely required for a correct application of microsurgical techniques.

[Microsurgery in gynecology. 8 years' clinical activity]. / La microchirurgia in ginecologia. Otto anni di attività clinica.

A series of 110 patients given surgical treatment for "mechanical infertility of varying origin in 1980-88 is examined". The classification system proposed for the microsurgical procedures available is based both on personal experience and on the classification of the causes of mechanical infertility in women according to aetiopathogenesis. Clinical results are judged in terms of pregnancies achieved and suggest that while adhesiotomy, salpyngostomy, t-t tubal anastomosis and cornual reimplantation are all useful, fimbrioplasty is less likely to give good results, particularly in the long term. Finally the links between gynaecological microsurgery and F.I.V.E.T. and G.I.F.T. are analysed.

Reversal of sterilization by microsurgical technique.

Tubal sterilization techniques that spare the fimbriae and cause the least amount of tubal destruction offer the best chance for reversal of sterilization. Patients seeking reversal of sterilization should be carefully selected. Surgical technique and equipment are important factors in reversal procedures; microsurgical techniques are shown to be more effective than macroscopic techniques.

PIP: Microsurgical techniques enables successful results in tubal anastomosis for reversal of sterilization. Patients in the study had all been sterilized at the medial isthmic segment. Ideally, in this case, there was no luminal disparity and a relatively thick circular muscle coat. After the pathologic or fibrotic tissue had been removed, a series of 8/0 nylon stitches, which include only the muscular coat, was carried out under microscopy. 6 or 7 stitches usually are sufficient to make a watertight anastomosis. A 2nd layer of 8/0 nylon stitches was used to repair the gap in the mesentery and the serosa overlying the fallopian tube. The patency of the anastomosis was inspected at 1 year from the date of the procedure by celiochromoscopy. The good results obtained are the result of the careful techniques of reconstruction using microscopy and the right instrumentation. In all cases, it is most important to consider the site of sterilization. The isthmo-isthmic site is regarded as the most ideal for microsurgical reversal because it is the easiest site for an anastomosis. Silber maintains that the prospect for a normal pregnancy, after reversal, is directly proportional to the length of the remaining tube which is the only critical factor, as long as there is at least 1 cm of ampulla. The time interval that passes between sterilization and surgical reversals also needs to be considered as an influencing factor in terms of the successful results of the tubal reconstruction.