Face-to-Face Two-Surgeons Four-Hands Microsurgery

  • Takanori FukushimaEmail author
  • Ali Zomorodi


Over the past 10 years, Fukushima established the gold standard of operatory room configuration as two-surgeons four-hands micro-neurosurgery, using face-to-face ocular arrangement of the modern floating operating microscope. Therefore, two surgeons observe equally with three-dimensional viewing field. This two-surgeons four-hands microsurgery will facilitate any microsurgical procedure from cerebrovascular to neoplastic microsurgical events. This new strategy requires a deep understanding of the alternative surgical anatomy shifted 90°–180°, relative to the standard looking view by a single surgeon. In this two-surgeons four-hands style of microsurgery, the Fukushima-designed wide dynamic range Universal Holding System provides multiple blunt hooks for fixing the soft tissues, drip irrigation, flexible brain spatula holder, and patty board without disturbing the surgeon’s operative field. The two-operator style provides very useful educational purposes. The resident or assistant surgeon is directly involved in the operation with real-time hands-on education.


Skull base/microsurgery Neurosurgery/operating microscope Skill base/two surgeons four hands 


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Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  1. 1.Division of Neurosurgery, Duke University Medical CenterCarolina Neuroscience InstituteRaleighUSA

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