title: Optical magnification should be mandatory for microsurgery: scientific basis and clinical data contributing to quality assurance.
abstract: BACKGROUND
  Microsurgical techniques are considered standard procedures in reconstructive surgery. 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 loupe should be used. Therefore, we conducted standardized experiments to objectively assess the impact of optical magnification in microsurgery.
  
  
  METHODS
  Sixteen participants of microsurgical training courses had to complete 2 sets of experiments. Each set had to be performed with an unaided eye, surgical loupes, and a regular operating microscope. The first set of experiments included coaptation of a chicken femoral nerve, and the second set consisted of anastomosing porcine coronary arteries. Evaluation of the sutured nerves and vessels were performed by 2 experienced microsurgeons using an operating microscope.
  
  
  RESULTS
  The 16 participants of the study completed all of the experiments. The nerve coaptation and vascular anastomoses exercises showed a direct relationship of error frequency and lower optical magnification, meaning that the highest number of microsurgical errors occurred with the unaided eye. For nerve coaptation, there was a strong relationship (P<0.05) between the number of mistakes and magnification, and this relationship was very strong (P<0.01) for vascular anastomoses.
  
  
  CONCLUSIONS
  We were able to prove that microsurgical success is directly related to optical magnification. The human eye's ability to discriminate potentially important anatomical structures is limited, which might be detrimental for clinical results. Although not legally mandatory, surgeries such as reparative surgery after hand trauma should be conducted with magnifying devices for achieving optimal patient outcomes.
authors.affiliation: Department of Trauma Surgery, General Hospital Linz, Linz, Austria. ; maz - Microsurgical Training Center, Linz, Austria.
authors.forename: Harald
authors.initials: H
authors.lastname: Schoeffl
authors.forename: Davide
authors.initials: D
authors.lastname: Lazzeri
authors.forename: Richard
authors.initials: R
authors.lastname: Schnelzer
authors.forename: Stefan M
authors.initials: SM
authors.lastname: Froschauer
authors.forename: Georg M
authors.initials: GM
authors.lastname: Huemer
keywords: Microscope; Microsurgery; Optical magnification; Surgical loupes; Training