title: Minimally invasive lymphatic supermicrosurgery (MILS): indocyanine green lymphography-guided simultaneous multisite lymphaticovenular anastomoses via millimeter skin incisions.
abstract: Among various surgical treatments, lymphaticovenular anastomosis (LVA), which bypasses congested lymph into venous circulation, is the least invasive surgical treatment. However, it usually entails skin incisions of around 3 cm, and operation time of around 4 hours. With multiple supermicrosurgeons under guidance of indocyanine green lymphography, LVAs can be simultaneously performed under local anesthesia within approximately 2 hours via small skin incisions with length less than 1 cm, allowing minimally invasive lymphatic supermicrosurgery (MILS). We performed MILS on 11 limbs of compression-refractory peripheral lymphedema cases. Length of skin incision for LVA ranged from 1 to 9 mm. Average operation time was 1.82 hours. Of the 11 limbs, 10 showed postoperative volume reduction. Indocyanine green lymphography clearly visualizes superficial lymph flows, which helps us to decide precise skin incision sites and find lymphatic vessels in LVA surgery, shortening skin incision length and operation time. Minimally invasive lymphatic supermicrosurgery can serve as the most reasonable treatment of compression-refractory peripheral lymphedema.
authors.affiliation: From the Department of Plastic and Reconstructive Surgery, Graduate School of Medicine, University of Tokyo, Bunkyo-ku, Tokyo, Japan.
authors.forename: Takumi
authors.initials: T
authors.lastname: Yamamoto
authors.forename: Mitsunaga
authors.initials: M
authors.lastname: Narushima
authors.forename: Hidehiko
authors.initials: H
authors.lastname: Yoshimatsu
authors.forename: Yukio
authors.initials: Y
authors.lastname: Seki
authors.forename: Nana
authors.initials: N
authors.lastname: Yamamoto
authors.forename: Aiko
authors.initials: A
authors.lastname: Oka
authors.forename: Hisako
authors.initials: H
authors.lastname: Hara
authors.forename: Isao
authors.initials: I
authors.lastname: Koshima
mesh_terms: D000368:Aged; D000714:Anastomosis, Surgical; D001132:Arm; D004396:Coloring Agents; D005260:Female; D006801:Humans; D007208:Indocyanine Green; D007866:Leg; D042601:Lymphatic Vessels / Q000000981:diagnostic imaging / Q000601:surgery*; D008209:Lymphedema / Q000601:surgery*; D008220:Lymphography; D008297:Male; D008866:Microsurgery / Q000379:methods*; D008875:Middle Aged; D061646:Operative Time; D010690:Phlebography; D015641:Radiography, Interventional / Q000379:methods*; D016896:Treatment Outcome; D014699:Venules / Q000000981:diagnostic imaging / Q000601:surgery*
chemical_list: D004396:Coloring Agents; D007208:Indocyanine Green