title: Lambda-shaped anastomosis with intravascular stenting method for safe and effective lymphaticovenular anastomosis.
abstract: BACKGROUND
  Lymphaticovenular anastomosis has become an increasingly common treatment for lymphedema. Supermicrosurgical techniques are essential for the successful performance of lymphaticovenular anastomosis. A positive correlation between the number of lymphaticovenular anastomoses performed and therapeutic efficacy has been reported, and in performing these anastomoses, the establishment of as many bypasses as possible is important.
  
  
  METHODS
  Forty limbs of 20 patients with lower extremity lymphedema who underwent lymphaticovenular anastomosis in our department were assessed. All cases were performed under local anesthesia using two to four surgical microscopes. A new method of anastomosis, lambda-shaped anastomosis assisted by intravascular stenting, was chosen in required cases.
  
  
  RESULTS
  Lymphaticovenular anastomoses resulted in 186 anastomoses on 20 patients with lower extremity lymphedema; the average number of anastomoses per case was 9.3 (range, five to 18). The number of surgical microscopes used ranged from two to four (average, 3.3), and the duration of the operation ranged from 3 to 5 hours (average, 4.1). In the cases of lambda-shaped anastomosis (n = 11), the number of anastomoses was significantly greater than in the cases without lambda-shaped anastomosis (n = 9; 10.2 ± 2.3 versus 8.2 ± 1.4; p < 0.05).
  
  
  CONCLUSIONS
  Lambda-shaped anastomosis assisted by intravascular stenting is a safe and relatively easy method that can be performed by surgeons with less than 1 year of experience in microsurgery. This in turn allows efficient lymphaticovenular anastomoses to be performed simultaneously by a team of surgeons, resulting in an increased number of bypasses.
authors.affiliation: Tokyo, Japan From the Department of Plastic and Reconstructive Surgery, Graduate School of Medicine, University of Tokyo.
authors.forename: Takumi
authors.initials: T
authors.lastname: Yamamoto
authors.forename: Mitsunaga
authors.initials: M
authors.lastname: Narushima
authors.forename: Kazuki
authors.initials: K
authors.lastname: Kikuchi
authors.forename: Hidehiko
authors.initials: H
authors.lastname: Yoshimatsu
authors.forename: Takeshi
authors.initials: T
authors.lastname: Todokoro
authors.forename: Makoto
authors.initials: M
authors.lastname: Mihara
authors.forename: Isao
authors.initials: I
authors.lastname: Koshima
mesh_terms: D000328:Adult; D000368:Aged; D000714:Anastomosis, Surgical / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D035002:Lower Extremity / Q000601:surgery; D042601:Lymphatic Vessels / Q000601:surgery*; D008209:Lymphedema / Q000601:surgery*; D008297:Male; D008866:Microsurgery / Q000379:methods*; D008875:Middle Aged; D012189:Retrospective Studies; D015607:Stents; D016896:Treatment Outcome; D014656:Vascular Surgical Procedures / Q000379:methods*; D014699:Venules / Q000601:surgery*; D055815:Young Adult