Introduction: For the microsurgical performance, the microsurgeon needs to see the field magnified with a good resolution degree. It would be great if the best physical and visual comfort for the microsurgeon and his team could be also achieved. These two requirements could be simply presented through the endoscope.

Aim of the work: Rather than our previous successful experimental application of the endoscope as a visual assistant in the field of microsurgery, the question this project seeks to answer is: Can microvascular surgery be performed in the clinical situations with use of the endoscope? An initial experience in 10 cases is presented.

Material & Methods: An endoscopic unit was used as a visual assistant over the operative field for the microvascular anastomoses, of the vascular pedicles of 10 free flaps; DIEP and ALT perforator flaps, to their corresponding recipient vessels of the internal mammary, and facial vessels in cases of breast and head and neck reconstructions respectively. The concerned technical aspects as regard handling of the instruments, eye-to-hand co-ordination, the degree of magnification, the working distance, the diameter of the operative field, resolution and quality of the two-dimensional image and the surgeon's own physical status were recorded.

Results: The technical and clinical data of the 20 vascular anastomoses of the 10 flaps were collected and assessed and compared with the conventional experiences using the operating microscope. All the microsurgical procedure steps have been performed with a maximum comfort as regard dissection, clamp application, vascular end preparation, irrigation and the microvascular anastomoses. The surgeon physical status was in an excellent visual and physical comfort compared to the microscope. Handling of the instruments, adjustment of the zoom and focus were done without recorded difficulties. The endoscopic image, magnification, working distance, range of movement and operarive field were very suitable.

Discussion: The endoscope seems to be a promising new tool in performing microsurgery with much better technical aspects. According to the feasibilities and difficulties of this project, we tried to establish a schematic imagination of the future routine use of an endoscopic microsurgical unit. The idea of the endoscopic assisted microsurgery is presented and might be compatible to the new generations of the microsurgeons and in special operative situations.