Revisiting microsurgical principles for the minimally invasive surgeon.

OBJECTIVE

To demonstrate basic microsurgical techniques and revisit the importance of following microsurgical principles in minimally invasive surgery.

DESIGN

Video demonstration of various surgical cases portraying proper microsurgical techniques as well as the consequences of deviating from these principles.

SETTING

Tertiary referral practice.

PATIENT(S): Reproductive-aged women with a desire to preserve reproductive organs and fertility potential.

INTERVENTION(S): We present surgical cases demonstrating the management of tubal and paratubal pathologies in which extra care must be taken to avoid inadvertent injuries of normal anatomic structures. We also portray the proper management of ovarian dermoid cysts and endometriomas to maximize the preservation of ovarian reserve and minimize complications. We have stressed the importance of ensuring safe tissue containment and extraction to avoid complications such as port site metastasis along with parasitic and iatrogenic myomas.

MAIN OUTCOME MEASURE(S): Implementation of microsurgical techniques including delicate tissue handling, judicious use of energy sources, and proper tissue containment and extraction.

RESULT(S): Nonadherence to microsurgical principles can result in detrimental surgical outcomes, including adhesions, parasitic myomas, port site metastasis, peritonitis, and compromised ovarian reserve.

CONCLUSION(S): Microsurgical principles are of paramount importance to improve patient outcomes in reproductive surgeries. These tenets should be uniformly applied in all surgical procedures. As surgeons who perform minimally invasive surgeries, we must revisit these principles and advocate for their training and universal implementation.