Medicine: Thinking Small

Scratch a surgeon and you will find a man sublimely confident that his fine needlework would put any seamstress to shame. But last week in San Francisco, many a needle-proud member of the American College of Surgeons took a microscopic look at his own handiwork and had to admit that there might be room for improvement.

The setting was a scientific exhibit put on by a University of Vermont surgical team headed by Dr. Julius H. Jacobson

II. Surgeon Jacobson, who began his medical career as a physiologist, was operating on dogs to produce a condition like human arterial disease when he found their smaller blood vessels hard to stitch by conventional means. He knew that eye-and-ear surgeons did some of their most delicate work with the aid of a surgical dissecting microscope and decided to try it himself.

The Zeiss stereo microscope can be set to give magnifications of six to 40 diameters. The best for arterial work proved to be 25 power, but Dr. Jacobson found that his surgical instruments and suture materials were then too big and clumsy.

He got miniaturized tweezers from a jeweler, who used them on watch springs.

With special hairbreadth suture threads, Dr. Jacobson and colleagues found that they could make good joins in many of the body’s tubes (arteries, veins, bile ducts, Fallopian tubes and ureters) even when the vessels were only 1½ mm. in diameter. They claim consistently good results — meaning that the tubes stay open indefinitely — in vessels only 4 mm. thick, with 20 tiny stitches.

Several surgeons who at first boasted that they could work just as well down to the 4-mm. level without the microscope were dismayed to find that magnification of their sutures disclosed a rough join that had no chance of staying open. Others, loath to give up their pride of craft, were harder to convince, fearing that the microscope would get in their way. But Dr. Jacobson won many converts to microsurgery. “The surgeon,” he said, “must think small. If he will do that, we shall be able to operate on small arteries in the heart and brain so that many heart attacks and strokes will be come routine surgical emergencies, like acute appendicitis.”