Microsurgery Tutorials. Lesson 9: Terminal - Terminal Anastomosis, Rat Carotid Artery

A series of tutorials on microsurgery, starting from the basics working up to more advanced techniques, uploaded in random order.
All videos: https://www.youtube.com/user/DrWmicrosurgery/videos

Copyright 2012 Victor Volovici (DrW).

Carl Zeiss Opmi Pico Microscope, no colour filter applied, magnification 20x-50x.
The carotid area is dissected as shown in the carotid dissection video, lesson 8 with great care not to remove any structures or ligate vessels. The technique is the same as with all terminal terminal anastomoses, but the carotid is the most difficult to carry out due to the confined area, importance of the vessel, susceptibility of the brain to hypoxic injury and very small size of the vessel, in small rats being 0.8-0.7 mm.
The background and approximator are placed, the artery cut and heparin, warm saline and lidocain applied in the vicinity of the stubs. The cardinal sutures at 12 and 6 o'clock are placed, posterior wall executed and finished, followed by the anterior wall. The distal arm is opened and if minimal bleeding ensues a new knot may be placed. Alternatively Surgicel or flushing with saline could be a solution. The point is not to let the blood flow be turbulent or too great. If it is slow, one needs to wait it out before opening the proximal arm. The proximal arm is opened, the operating field flushed with saline and the anastomosis checked again. The skin is closed with 7/0 USP polyglactin 910 absorbable suture. Paracetamol is used for postoperative anesthaesia.
More videos to come!
Song: John Williams The Imperial March. I do not own or claim authorship for the song.