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Curr Opin Urol
provided an outstanding overview of the history of
microsurgery in urology. Most of the discussion revolves around
the application of microsurgery to treatment of male reproduc-
tive dysfunction, not other areas of urology. The use of
cation and enhanced imaging is certainly expanding to
other areas of urology. For example, if one considers microsur-
gery to include use of loupe magni
cation for microsurgical
then robotic and laparoscopic surgery could
well be considered advances of optically magni
ed surgery in
The major advances with every microsurgical procedure are
well documented with clear examples of the major contributors
and important steps in development of the operations. The
reader has the opportunity to better understand how these ad-
vances have occurred, which is helpful for those in training as
well as in practice
and perhaps consider how additional in-
novations in surgical technique occur.
It is interesting that the studies quoted are almost all
observational studies, with few controlled studies for most of
the new microsurgical techniques. In most cases, the im-
provements in microsurgery have been incremental rather than
quantum leaps forward or major technologic advances because
the technology is use of an operating microscope and micro-
Finally, it is important to consider that future innovations will
need to be evaluated with cost considerations, as well as simple
evaluation of the outcomes achieved with each surgical tech-
nique. The authors
are to be commended for their thoughtful
overview of the history of microsurgery in urology.
Peter N. Schlegel, M.D.,
Department of Urology, Weill
Cornell Medical College, New York, NY
Pastuszak AW, Wenker EP, Lipshultz LI. The history of microsurgery
Silber SJ, Crudop J. Kidney transplantation in inbred rats.
Am J Surg
85: 974, 2015.
2015 Elsevier Inc.
The inspiration for compiling the history of microsurgery in
urology arose from the authors
fascination with microsurgical
technique and applications and a desire to understand how
current approaches to microsurgical applications resulted from a
gradual, progressive, innovation process.
It is tempting to speculate about future technologies and
how they may further revolutionize contemporary microsur-
ed laparoscopic and robotic surgery can certainly
be considered advances in
facilitating access to structures previously requiring a large
incision followed by a precise approach requiring magni
tion. The future of microsurgery will likely incorporate novel
UROLOGY 85 (5), 2015