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Background We have newly developed a novel “grip-type” gun-shaped microsurgical needle holder that requires only finger twisting between the thumb and index finger for needle advancement. This study aimed to objectively assess whether this grip-type needle holder could reduce forearm muscle movement during microsurgical suturing as compared with a conventional pen-type needle holder by means of surface electromyography (sEMG).Methods Extensor carpi ulnaris (ECU) muscle and flexor carpi ulnaris muscle (FCU) sEMG measurements were taken during needle advancement in a microvascular anastomosis model for calculation of root mean square (RMS) values. The summed ECU and FCU RMS values were employed as indicators of forearm muscle movement and compared between the pen-type and grip-type instruments. Analyses of eight subjects and suturing in five directions by one subject were conducted.Results The summed ECU and FCU RMS values of the grip-type holder were significantly smaller than those of the pen-type holder in comparisons of eight subjects (p Conclusion The grip-type needle holder could significantly reduce forearm muscle movement as compared with a conventional pen-type holder based on objective sEMG measurements. The grip-type device appears more ideally suited for delicate microsurgical suturing, such as lymphaticovenular anastomosis or finger replantation, since the reduced forearm movement may mitigate the risk of coarse motion and hand shaking.

Background Although lymphedema is fundamentally abnormal accumulation of excess water in the extracellular space, previous studies have evaluated the efficacy of physiological bypass surgery (lymphaticovenular anastomosis [LVA]) for lymphedema without measuring water volume. This study clarified the water reductive effect of LVA using bioelectrical impedance analysis (BIA). Methods The efficacy of LVA for unilateral lower-limb lymphedema was evaluated using BIA in a retrospective cohort. The water volume of affected and unaffected legs was measured using multifrequency BIA before and after LVA. Preoperative measurements were undertaken after compression therapy for at least 3 months. The follow-up period after LVA was a minimum of 6 months. Results Thirty consecutive patients with unilateral lower-limb lymphedema were enrolled. The mean water volume reduction of the affected leg by LVA (ΔLBW) was 0.86 L (standard deviation [SD]: 0.86, median: 0.65) with a mean number of 3.3 anastomoses (SD: 1.7). The mean reduction rate of edema was 45.1% (SD: 36.3). Multiple linear regression analysis revealed water volume difference between the affected and unaffected legs before LVA (excess LBW) as the strongest predictor of ΔLBW (R 2 = 0.759, p Conclusion The LVA reduces the volume of accumulated body water in lower-limb lymphedema. As excess LBW most strongly predicted the amount of water volume reduction by LVA, body water volume measurement by BIA before LVA might identify patients with low excess LBW not expected to benefit from LVA, regardless of apparent differences in limb circumference.