The conventional approach of looking down a microscope to perform microsurgical procedures is associated with occupational injuries, anti-ergonomic postures, and increased tremor and fatigue, all of which predispose microsurgeons to early retirement. Recently, three-dimensional (3D) visualization of real-time microscope magnification has been developed as an alternative. Despite its commercial availability, no supermicrosurgical procedures have been reported using this technology to date. Lymphovenous anastomoses (LVAs) often require suturing vessels with diameters of 0.2–0.8 mm, thus representing the ultimate microsurgical challenge. After performing the first documented LVA procedure using 3D-augmented visualization in our unit and gaining experience with this technique, we conducted an anonymized in-house survey among microsurgeons who had used this approach. The participants considered that 3D visualization for supermicrosurgery was equivalent in terms of handling, optical detail, depth resolution, and safety to conventional binocular magnification. This survey revealed that team communication, resident education, and ergonomics were superior using 3D digital hybrid visualization. Postoperative muscle fatigue, tremor, and pain were also reduced. The major drawbacks of the 3D visualization microscopic systems are the associated costs, required space, and difficulty of visualizing the lymphatic contrast used.

Present work was designed to quantitatively evaluate the performance of diffusion-weighted magnetic resonance imaging (DWI) in the diagnosis of the presence of metastasis in lymph nodes (LNs).Eligible studies were identified from systematical PubMed and EMBASE searches.Data were extracted.Meta-analyses were performed to generate pooled sensitivity and specificity on the basis of per-node,per-lesion and per-patient,respectively.Fourteen publications (2458 LNs,404 lesions and 334 patients) were eligible.Per-node basis demonstrated the pooled sensitivity and specificity was 0.82 (P＜0.0001) and 0.90 (P＜0.0001),respectively.Per-lesion basis illustrated the pooled sensitivity and specificity was 0.73 (P=-0.0036) and 0.85 (P＜0.0001),respectively.Per-patient basis indicated the pooled sensitivity and specificity was 0.67 (P=0.0909) and 0.86 (P＜0.0001),respectively.In conclusion,DWI has rather a negative predictive value for the diagnosis of LN metastasis presence.The difference of the mean apparent diffusion coefficients between benign and malignant LNs is not yet stable.Therefore,the DWI technique has to be further improved.

The conventional approach of looking down a microscope to perform microsurgical procedures is associated with occupational injuries, anti-ergonomic postures, and increased tremor and fatigue, all of which predispose microsurgeons to early retirement. Recently, three-dimensional (3D) visualization of real-time microscope magnification has been developed as an alternative. Despite its commercial availability, no supermicrosurgical procedures have been reported using this technology to date. Lymphovenous anastomoses (LVAs) often require suturing vessels with diameters of 0.2–0.8 mm, thus representing the ultimate microsurgical challenge. After performing the first documented LVA procedure using 3D-augmented visualization in our unit and gaining experience with this technique, we conducted an anonymized in-house survey among microsurgeons who had used this approach. The participants considered that 3D visualization for supermicrosurgery was equivalent in terms of handling, optical detail, depth resolution, and safety to conventional binocular magnification. This survey revealed that team communication, resident education, and ergonomics were superior using 3D digital hybrid visualization. Postoperative muscle fatigue, tremor, and pain were also reduced. The major drawbacks of the 3D visualization microscopic systems are the associated costs, required space, and difficulty of visualizing the lymphatic contrast used.