MAGNIFICATION IN SUGERY

OPERATING MICROSCOPE 2




HOW TO CONTROL the functions of the microcope during surgery?

In the case of the manual microscope, all controls such as
Focusing, magnification, change the tilt of the microscope, are
Done by different hand knobs.
- These can be covered with sterilzable rubber caps provided
with the microscope OR
\
- The complete instrument (besides the eye pieces) can be draped with a loose sterile plastic drape, and the knobs adjusted through this drape
OR
With motorized microscopes, the functions are controlled by a foot switch.
- The controls can also be built into a specially designed
surgeons Operating chair. OR

- Alternatively a hand switch, inserted into a sterile plastic
bag for use during operation

What are the parts of the ASSISTANTS' MICROSCOPE ATTACHMENT?
An assistant’s microscope is a separate binocular viewing
system with eye pieces.
-It provides the same stereo image as seen in the main microscope.
-This is through a beam splitter, which splits the image and directs it to the assistants' microscope, which has its own independent magnification control.
-This makes it possible for the assistant to participate and
assist in Surgical procedures.

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MAGNIFICATION IN SURGERY

OPERATING MICROSCOPES

WHAT ARE THE USES OF MAGNIFICATION?
The use of controlled magnification has been a recent addition to the instrument list.

Loupes and magnifying glasses have been used in the past, but operating microscopes have improved the clarity ease of use, the depth of focus, and the lighting of the site of the operation.
Complicated two layer suture on small structures
- can be performed quickly,
- accurately and in comfort
- With no strain on the neck muscles.
Operating microscope can be:
1. Floor Mounted Fig 6.1
2. Ceiling Mounted Fig 6.2

What are the Features of an Operating Microscope?
They can be;
* Hand operation or foot operation microscopes for focus
* Automatic focuses and zooms
* Can have Assistant Microscope view arm so he can view and assist
* Camera attachment arm for recording procedures.

WHERE IS a microscope USED?

The operating microscope is used for two purposes:
- The first is to provide a magnified view of small structures
(Small vessel and nerve anastmosis).
- The second is to provide a magnified view of larger
Structure upon which more precise surgical procedure needs
To be performed (Disc surgery).

Explain what ARE THE features OF OPERATING MICROSCOPES?

There are two basic types of operating microscope, with
Several variations, depending upon the surgical specialty
Involved.
- The first is the manual type, featuring hand controlled
Fixed magnification stepwise(x6x9...) and control knobs for
Focus Fig. 6.3
- The second type is the zoom system, this has the advantage
Of offering continuous magnification through the whole range
Of the magnification of the system including focus through
Foot controls.
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WOUND CLOSURE 7

SUTURES AND LIGATURES NON ABSORBABLE 2



Metallic wire

Suture wire is prepared mainly from three metals –
non-toxic Stainless steel,
the alloy Tantalum and
Silver.

All these may be obtained as a single-strand monofilament
suture
The first two as several strands, either twisted or
braided, known as multifilament wire.

Surgical stainless steel suture wire is used mainly in
orthopaedics and thoracic surgery.
A stouter wire of sizes 3 to 9(0 to 7) or 29 SWG would be needed for wiring fragments of bone together.

Metal clips (ligature)

Ligatures of flattened silver or tantalum wire are used in
Neurosurgery, and chest surgery, for arresting hemorrhage from
small vessels.
The insertion forceps and cartridges, allow their use for this purpose at depths with safety Fig 5.4.5.1

Metal clips (suture)

These are metal clips having two sharp points which when the
clip is closed, these points grip the edges of the skin incision
and hold them in apposition.

The original types in use are Michel and Kifa Fig 5.4.6.2

Staples

During the past few years there has been considerable
development in the field of suture staples.

These range from disposable magazines of staples which fit
an insertion instrument to completely disposable units.
Examples of two of the latter are
Proximate II(Ethicon) and
Appose (Davis & Geck) Fig 5.4.7.1a,b,c
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WOUND CLOSURE 6

WHAT ARE THE SYNTHETIC NON-ABSORBABLES?

Polymide (Nylon) Mono-filament

This is a single strand of polyamide supplied in sizes
rangeing from 0.2 to 2 (10/0 to 2).

The material can be obtained in multiple pre-cut lengths,
from 35 cm to 1 m.

Polyamide as a single thread is inert and can be safely used
in the presence of infection. It may be left in the tissues with
very little reaction occurring.

Monofilament examples of this material include Ethilon, blue
(Ethicon);
Surgidek, blue or black (Surgicraft); and
Dermalon, white, blue or black (Davis & Geck).

BRAIDED

This is used in a similar manner to braided silk.
The sizes available range from 0.7 (6/0) to 2(5), with the same tensile strengths as braided silk.
The two colours available, black and blue.
It is generally supplied in multiple pre-cut lengths of
between 35 cm (14 in) and 1 m(40 in), sterile in peel-open packs.
The material is available also armed with non-traumatic needles.

Examples of this material include Nurolon (Ethicon) and
Surgilon (Davis and Geck).

Polypropylene

The material is available in sizes 0.2 to 5 (10/0 to 2),
with or without needles.
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