Abstract
Background Supermicrosurgical lymphaticovenular anastomosis (LVA) is a promising treatment modality
for lymphedema. However, its practice is restricted by the surgeon/equipment-related
factors, and its effectiveness limited by technical constraints. We conducted a pilot
study to evaluate the feasibility of a modified “octopus” LVA technique in addressing
the above problems.
Method Nine consecutive lymphedema patients underwent LVA procedure using the “octopus”
technique. Six had the upper extremity disease; three had the lower extremity disease.
Except for one patient having primary lower extremity lymphedema, all had secondary
disease related to cancer treatment. Disease severity ranged from Campisi stage Ib
to IV. Qualitative and quantitative assessments were performed preoperatively, at
1, 3, and 6 months.
Results A total of 130 lymphaticovenular drainage pathways were created in 39 “octopus” LVAs.
All patients experienced prompt relief of lymphedema symptoms during the 1st postoperative
week and continued to improve during the study period. None had postoperative complications.
All had disease regression as demonstrated by statistically significant decrease in
limb measurements (p = 0.0003) and severity down-staging. The modified technique was found to be easier
than the standard supermicrosurgical technique and could be performed using a standard
surgical microscope.
Conclusion The “octopus” technique is a viable, effective technical alternative to the standard
LVA technique. It may greatly simplify this technically challenging procedure.
Keywords
supermicrosurgery - lymphaticovenular anastomosis - LVA - lymphedema surgery
