Navigation lymphatic supermicrosurgery for the treatment of cancer-related peripheral lymphedema.
BACKGROUND
Lymphatic supermicrosurgery is becoming the treatment of choice for refractory lymphedema. Detection and anastomosis of functional lymphatic vessels are important for lymphatic supermicrosurgery.


METHODS
Navigation lymphatic supermicrosurgery was performed using an operating microscope equipped with an integrated near-infrared illumination system (OPMI Pentero Infrared 800; Carl Zeiss, Oberkochen, Germany). Eight patients with extremity lymphedema who underwent navigation lymphatic supermicrosurgery were evaluated.


RESULTS
A total of 21 lymphaticovenular anastomoses were performed on 8 limbs through 14 skin incisions. Lymphatic vessels were enhanced by intraoperative microscopic indocyanine green (ICG) lymphography in 12 of the 14 skin incisions, which resulted in early dissection of lymphatic vessels. All anastomoses showed good anastomosis patency after completion of anastomoses. Postoperative extremity lymphedema index decreased in all limbs.


CONCLUSIONS
Navigation lymphatic supermicrosurgery, in which lymphatic vessels are visualized with intraoperative microscopic ICG lymphography, allows a lymphatic supermicrosurgeon to find and dissect lymphatic vessels earlier and facilitates successful performance of lymphaticovenular anastomosis.
1Department of Plastic and Reconstructive Surgery, the University of Tokyo, Bunkyo-ku, Tokyo, Japan.
Takumi
T
Yamamoto
Nana
N
Yamamoto
Takao
T
Numahata
Ai
A
Yokoyama
Kensuke
K
Tashiro
Hidehiko
H
Yoshimatsu
Mitsunaga
M
Narushima
Isao
I
Koshima
D000328:Adult; D000368:Aged; D000714:Anastomosis, Surgical; D001943:Breast Neoplasms / Q000628:therapy*; D004867:Equipment Design; D005260:Female; D005456:Fluorescent Dyes; D006801:Humans; D007208:Indocyanine Green; D042601:Lymphatic Vessels / Q000601:surgery*; D008209:Lymphedema / Q000175:diagnosis / Q000209:etiology / Q000601:surgery*; D008220:Lymphography / Q000379:methods; D008853:Microscopy; D008866:Microsurgery / Q000295:instrumentation / Q000379:methods*; D008875:Middle Aged; D012720:Severity of Illness Index; D019265:Spectroscopy, Near-Infrared; D025321:Surgery, Computer-Assisted / Q000295:instrumentation; D016896:Treatment Outcome; D034941:Upper Extremity; D014594:Uterine Neoplasms / Q000628:therapy*
D005456:Fluorescent Dyes; D007208:Indocyanine Green
cancer; indocyanine green; lymphaticovenular anastomosis; lymphedema; navigation; supermicrosurgery