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J Reconstr Microsurg 2023; 39(02): 131-137
DOI: 10.1055/s-0042-1750123
Original Article

Office-Based Lymphatic Supermicrosurgery: Supermicrosurgical Lymphaticovenular Anastomosis at an Outpatient Clinic

Takumi Yamamoto
1   Department of Plastic and Reconstructive Surgery, Center Hospital of the National Center for Global Health and Medicine, Tokyo, Japan
2   Department of Plastic Surgery, Tokyo Metropolitan Bokutoh Hospital, Tokyo, Japan
,
Nana Yamamoto
1   Department of Plastic and Reconstructive Surgery, Center Hospital of the National Center for Global Health and Medicine, Tokyo, Japan
2   Department of Plastic Surgery, Tokyo Metropolitan Bokutoh Hospital, Tokyo, Japan
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Abstract

Background Supermicrosurgical lymphaticovenular anastomosis (LVA) has become popular for the treatment of compression-refractory lymphedema. With advancement of navigation tools, LVA can be performed with more ease and safety, allowing office-based LVA at an outpatient clinic.

Methods Office-based LVA was performed on patients with compression-refractory secondary extremity lymphedema by a well-experienced supermicrosurgeon (T.Y.) under local infiltration anesthesia. Indocyanine green (ICG) lymphography and vein visualizer were used to localize vessels preoperatively. A stereoscopic microscope (Leica S6E, Leica Microsystems, Germany) or a relatively small operative microscope (OPMI pico, Carl Zeiss, Germany) was used for LVA. Operative records and postoperative results were reviewed to evaluate feasibility of office-based LVA.

Results LVAs were performed on 27 arms and 42 legs, which resulted in 131 anastomoses via 117 incisions. ICG lymphography stage included stage II in 47 limbs, and stage III in 22 limbs. Time required for one LVA procedure (from skin incision to skin closure in one surgical field) ranged from 13 to 37 minutes (average, 24.9 minutes). One year after LVA, all cases showed significant volume reduction (lymphedematous volume reduction; 0.5–23.6%, average 13.23%). No postoperative complication was observed.

Conclusion LVA can be performed with safety and effectiveness outside an operation theater. Patient selection, precise preoperative mapping, and experience of a surgeon are key to successful office-based LVA.

Keywords

lymphedema - microsurgery - supermicrosurgery - indocyanine green - anastomosis

Prior Presentations

We presented in part at the 22nd Annual Congress of the Japan Society for Innovative Techniques in Plastic Surgery in Tokyo, Japan on February 18, 2017.


Disclaimers and Disclosure

None.


Ethics

This study was conducted under an ethical institutional review board-approved protocol (16–19).


Supplementary Material



Publication History

Received: 26 December 2021

Accepted: 23 April 2022

Article published online:
11 July 2022

© 2022. Thieme. All rights reserved.

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333 Seventh Avenue, 18th Floor, New York, NY 10001, USA

 

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