Microsurgery Hailed as Newest Frontier in Medicine : Breakthroughs Foreshadow Routine Operations on Fetuses, Repair of Attached Organs
Microsurgeons predict that within 15 years they will be able to perform routine operations on fetuses developing in the womb and to negate the need for transplant surgery by repairing hearts, kidneys and livers before returning the organs to the body.
“Microsurgical research and techniques being developed around the world today will radically transform the health care profession and hospitals before the year 2000,” said Dr. Sebastian Arena, director of Mercy Hospital’s microsurgery laboratory.
Technology, which made advances in the delicate art of microsurgery possible, will again play the crucial role in determining whether surgery can be performed on fetuses in the womb. Such surgery has been successful in monkeys and may be possible on humans within five years.
Before the turn of the next century, microsurgeons hope to be able to perform so-called bench surgery--taking out vital organs, repairing them and returning them to the body. Not only will the number of organ transplants be reduced, but the amount of damage done to surrounding organs, tissues and blood vessels during any organ surgery will be minimized.
“The next step (in microsurgery) is to miniaturize all surgery (with lasers and robotics) because most of the trauma associated with surgery occurs while getting into and out of the body,” said Dr. Earl Owen of the Sydney, Australia, Microsurgery Center.
The frontier of microsurgery began with Alexis Carrel, who won a Nobel Prize for blood vessel research in 1915. But he never got far in the field because he mistakenly assumed that blood vessels would naturally rejoin when he attempted to reattach severed limbs on animals.
Today, microscopes in operating rooms can magnify patients’ blood vessels up to 40 times, enabling surgeons to use hair-thin nylon threads to join blood vessels thinner than a piece of cardboard.
Surgeons use stainless steel instruments, which they manipulate by applying subtle pressure from their fingers and thumbs, to perform the delicate task. It’s a principle similar to a Formula One driver turning his car going 200 m.p.h. by slightly moving the steering wheel.
The surgeons use armrests to steady their arms during operations that last anywhere from 15 minutes to 15 hours, depending on whether they’re performing a kidney transplant in an infant, removing a benign growth from a vocal cord, reversing intentional sterility or replacing a lower jaw with a piece of a rib.
Dr. Joseph Y. S. Bao, the deputy chief of orthopedic surgery at Shanghai’s Sixth People’s Hospital in China, reattached the severed hands of a 42-day-old boy--a feat which amazed many American doctors because the infant was the youngest patient in the world to have a successful reimplantation operation.
Procedure Normally Avoided
Normally, microsurgeons won’t attempt such a procedure on infants because their tissues and blood vessels aren’t developed enough. As a result, they can’t be operated on until they’re 3 or 4 years old, said Dr. Donald Serafin, a professor of plastic, reconstructive and maxillofacial surgery at Duke University in Durham, N.C.
Serafin primarily is concerned with monitoring blood flow after limbs are reattached and also after tissue is transferred from one part of the body to another.
Because the human eye can see only arteries and veins, microsurgeons must use a laserdoppler to monitor blood flow in capillaries, the smallest blood vessels in the body. By reflecting light off capillaries and then recording a change in frequency, the instrument determines if blood is flowing and how well it’s flowing.
Serafin applies his techniques to children with birth defects and also to patients with severe burns.
If an infant is born without a thumb, surgeons now are able to remove one of his or her second toes and attach it to the hand. Although it doesn’t grow as well as a normal thumb, it surpasses the development of the other foot’s second toe and functions like a thumb within a year.
Before the first toe-to-hand operation was performed in the early 1970s, surgeons performed a procedure that was done over a three-month period. It involved making a tube from skin previously covering a portion of the stomach, attaching it to the hand, and then inserting a plastic rod into the tube. The new thumb, however, looked deformed and had limited mobility.
‘Best Way to Create Function’
“Microsurgery is the best way to create function,” said Serafin.
Serafin also performs reconstructive surgery which usually involves burn patients. If someone’s neck and face are severely burned, he transfers a flap of skin along with its underlying blood vessels from hidden areas, such as the back or groin, places it on the burned region, and then joins two to four vessels to existing vessels.
