The company of The da Vinci Surgical System gives many justifications encompassing the high definition 3D image, the wrist-like function, filtration of tremors, microanastomosis
, motion scaling, and tele-surgery.
Therefore, our experimental model, the elevation of a pedicled flap without microanastomosis
, does not seem like an ideal model.
In particular, free tissue transfer is a lengthy surgical procedure (6 21 hours in this series) where tissue is transferred from one area of the body to another and the blood vessels reconnected by microanastomosis
. Any compression of this anastomosis, for example by haematoma, can cause complete failure of the reconstruction.
A solid microsurgical technique for vascular microanastomosis
and nerve coaptation enables a good nerve and vessel healing, perhaps partly explaining our BMD findings in our patients.
Autologous cancellous bone graft has been considered more osteogenic as compared to cortical bone graft because the presence of spaces within their structure, allows the diffusion of nutrients and limited revascularization by microanastomosis
of its circulating vessels (10-12).
In fact, Kolker is correct when he states, "the decision to perform free flap microanastomosis
to clearly uninjured vessels proximal to the zone of injury [sic] must be weighed against the anatomic and technical difficulties of performing such an anastomosis." (4) However, in our population, the numbers of "selected" patients are relatively small and the amount of fibrosis and vascular damage is significant by the time the patient presents to the operating room for tissue coverage.
The surgeons performed a limited laminectomy and a lumbar ventral root microanastomosis
, usually L5 to S3.
In addition, while endoscopic microanastomosis
(microsurgery to connect blood vessels in transplantation of tissue using an endoscope) was successful, open microanastomosis
using a microscope was not.
Because of its complexity, the microanastomosis
technique cannot be acquired by observing more experienced surgeons.