Enhancing Microvascular Anastomosis Using an Axial-View Microscope

Abstract Under a conventional digital microscope, the cross-section of a vessel is visualized as a long oval because it is observed from a bird's-eye perspective (bird's-eye-view microscope, bMS). This limited perspective can hinder accurate identification of the vascular lumen and tunica intima during microvascular anastomosis. To overcome this limitation, we developed a novel microscope system that provides an axial view of the vascular stump (axial-view microscope, aMS). In this experimental study, we used our proprietary digital microscope, which integrates a low-resolution digital camera with the aMS system, and defined this system as the bMS. Ten chicken femoral arteries were used, and two arterial anastomoses were created for each artery. One anastomosis was performed using both the bMS and aMS (aMS-assisted group), whereas the other was performed using the bMS alone (bMS-only group). Anastomosis creation was divided into two stages. Stage 1 consisted of identifying the tunica intima and inserting the surgical needle through the vascular wall. Stage 2 included all remaining procedures, excluding rotation of the vascular clamp, intraluminal irrigation, and adjustment of vessel position. Operative times were recorded and compared between groups. The ratio of the average duration of Stage 1 (front and back sides combined) in the aMS-assisted group relative to the bMS-only group was 0.58 ± 0.19, indicating a significantly shorter Stage 1 duration with aMS use (p < 0.001). The ratio of the average total anastomosis time was 0.88 ± 0.08, demonstrating a significant reduction in overall anastomosis time in the aMS-assisted group (p < 0.001). The aMS provides direct visualization of the vascular cross-section and facilitates rapid identification of the tunica intima without prolonging other steps of microvascular anastomosis. These findings indicate that this system may enhance the operative view and reduce anastomosis time in microsurgical procedures.