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In the past, many surgeons have turned to using ophthalmic instruments for surgery in small exotic animals; however, they are not well suited for this purpose. Being made for surgery on a superficial structure, the eye, they are short making them more difficult to control and to manipulate tissues deep in a body cavity. Microsurgical instruments are manufactured so they are of a standard length and only the tips are miniaturized (Bennett 2009) (see Chapter 3). They are long enough for the instrument to balance in the hand while the tips extend beyond the surgeon's hand into the patient's body cavity (Figure 1.7). They should be counterbalanced to minimize hand fatigue. Round handles are recommended because the instruments should be rolled between the thumb and first two fingers rather than using wrist action. Having round handles is most important for needle holders because the curved needle has to be passed through the tissue using this rolling action between the thumb and fingers. Even with scissors and forceps, it is easier to roll them if the handles are round. Many surgeons prefer needle holders without box lock for delicate tissue because when the lock is set, the needle can jump and tear tissues. Hold a microsurgical instrument as if you were holding a pen (Figure 1.8a). An across‐the‐palm grip is inappropriate (Figure 1.8b). As a starting point, a microsurgical pack should contain a microsurgical needle holder, a microsurgical scissors, and microsurgical thumb forceps (Figure 1.9). Add other microsurgical instruments to the pack with increasing experience.

Figure 1.5 An Alm retractor (a) uses a thumb screw to open the jaws, while the Heiss retractor (b) has a quick release ratchet mechanism.

Figure 1.6 The Lone Star retractor system consists of a plastic ring with notches around the perimeter (a) and silastic bands with tissue hooks that are placed in the tissue to be retracted (b). Insert the bands into the notches in the ring to maintain tissue retraction.

Figure 1.7 Microsurgical instruments should be a standard length with miniaturized tips that extend beyond the hand into the tissue and should be counterbalanced to minimize hand fatigue.