Historically the some branches of surgery such as ophthalmology and otorhinolaryngology started to miniaturize early and start using microsurgery with the use of surgical microscopes. In the last quarter of 20th century, miniaturization started to develop most branches of surgery including neurosurgery and cataract surgery. The basic feature was minimization of trauma to the body tissues during surgery. Trends were small incisions, laparoscopic surgery by fiberoptic visualization through tubular devices, vascular surgery by catheters and microsurgery under operating or surgical microscopes to refine the procedures and reduce trauma. Many of the devices such as robotics and implants, aside from the surgical microscope, will be a part of this miniaturization process.

Advances in cataract surgery using surgical microscopes

Of all the fields of medicine, cataract surgery has been one of the greatest beneficiaries of advances in techniques and technology. Not so long ago, cataract surgery involved lengthy delays marked by deteriorating vision while the cataract “ripened,” an extended and confining recovery period, plus the need for unsightly “cataract” glasses or contact lenses to achieve functional vision after surgery. Now, the surgery is a simple under surgical microscopes and is an out-patient procedure. The stay at an ambulatory surgery center is just a few hours and recovery time after surgery using using surgical microscopes is dramatically reduced. Many people enjoy improved vision with minimal dependence upon corrective eyewear as a result of modern cataract surgery using surgical microscopes. A few short years ago, the accepted method of cataract surgery was to open the front portion of the eye and pluck the cataract like a grape. This meant that the cataract had to “mature” or “ripen” to the point that it was firm, making it easier for the surgeon to grasp. For the cataract to reach this stage, vision in the eye became dramatically impaired, often to the point of near blindness. At first, there were no suitable materials to use as sutures in the eye, so the eye had to be bandaged and heal on its own. This meant the patient was confined to bed with their head literally sandbagged to prevent movement that might jeopardize the healing process. “Cataract” glasses with thick lenses or contact lenses were required to assume the focusing power of the natural lens, which was removed during surgery and easy if done under surgical microscopes. Unfortunately, memories of this type of have caused many people to wait needlessly before having cataract surgery. Although sutures were a major advance, they have been supplanted in most cases by the use of a self-sealing incision. The shape of the incision creates a flap that takes advantage of the natural fluid pressure inside the eye to seal it shut without the need for sutures. Not every cataract surgery can be performed as a “No-Stitch” procedure. The decision to place a suture is made by the surgeon under surgical microscopes and always has best interests in mind. Cataract surgery using a surgical microscope is a delicate operation that involves manipulation of the tiny structures of the eye with the help of surgical microscopes. High-powered using surgical microscopes allow the surgeon to view the parts of the eye clearly. A large incision is no longer required to allow the cataract to be plucked from the eye like a grape. Now, just a tiny incision is necessary so that a probe approximately the width of a match stick can be used to remove the cataract. By use of ultrasound and a surgical microscope, the probe dissolves the cataract, allowing it to be gently vacuumed from the eye. Cataract surgery removes the cloudy, natural lens of the eye. Once the natural lens of the eye is gone, another means is needed to bring light rays into proper focus upon the retina. Tiny artificial lenses, called intraocular lenses, that could be placed inside the eye proved to be a dramatic solution to clear vision following cataract surgery. They are made of inert materials that do not trigger any rejection responses by the body. Through the use of careful measurements of the eye taken before surgery under surgical microscopes, the doctor may be able to select a lens power to correct for nearsightedness or farsightedness, which helped to reduce dependence upon corrective eye wear after the surgery. Glasses and then contact lenses were used after cataract surgery to perform this function. Unfortunately, both offer less than satisfactory solution.

Tiny artificial lenses, called intraocular lenses, that could be placed inside the eye proved to be a dramatic solution to clear vision following cataract surgery. A small opening is made in the front of the capsule that holds the natural lens. A tiny incision is made to allow for the insertion of a phacoemulsification tip which is used to remove the cataract. By use of ultrasound, the probe dissolves the cataract, allowing it to be gently vacuumed from the eye. By using soft material that can be folded, the artificial lens can be inserted inside the eye through the original surgical incision. The lens unfolds to fill the capsule much as the natural lens of the eye had done prior to cataract surgery. Cataract surgery is a pain-free experience thanks to advances in anesthesia. The patients are awake during the surgery and are able to resume normal activities shortly afterwards. During the relative quick procedure, the surgeon and members of his surgical team attend to the needs of the patient. Two types of anesthesia are used to keep patients comfortable and pain-free during surgery like topical and regional anesthesia.

Microsurgery using surgical microscopes

This is often the first step in treating tumors that can be removed with an acceptable risk of nerve damage. What’s more, new techniques and instruments allow neurosurgeons to reach tumors that were once inaccessible. The high-powered surgical microscopes used in microsurgery, for instance, make it easier to distinguish tumors from healthy tissue. Doctors also can test different nerves, using surgical microscopes, during surgery with electrodes, thus minimizing neurological damage. And in some instances, they may use sound waves to break up tumors and remove the remaining fragments. But even with these advances in treatment, not all tumors can be removed completely. Surgical removal is the best option for many intramedullary and intradural-extramedullary tumors, yet large ependymomas at the end of the spine may be impossible to extricate from the many spinal nerves in this area. And although benign tumors in the vertebrae can usually be completely removed, metastatic tumors are less likely to be operable. When a tumor has metastasized to the spine, radiation is usually the treatment of choice. In these cases, surgery using surgical microscopes is reserved for people who do not have a diagnosis, who have tumors resistant to radiation or recurrent tumors that were previously irradiated. Recovery from spinal surgery may take weeks or months, depending on the procedure, and the patient may experience a temporary loss of sensation or other complications.