title: Navigation lymphatic supermicrosurgery for iatrogenic lymphorrhea: supermicrosurgical lymphaticolymphatic anastomosis and lymphaticovenular anastomosis under indocyanine green lymphography navigation.
abstract: BACKGROUND
  Lymphorrhea can occur after surgical intervention to the lymphatic system. Most cases with lymphorrhea can be treated conservatively, but some cases are refractory to conservative treatments and require further surgical treatments.
  
  
  METHODS
  Eight patients developed inguinal lymphorrhea after surgical intervention in the groin region. Navigation lymphatic supermicrosurgery (NLS) was performed for the treatment of iatrogenic lymphorrhea refractory to conservative treatments. Lymphatic vessels ruptured in a lymphorrhea lesion were identified under intraoperative indocyanine green (ICG) lymphography navigation and were anastomosed to a recipient vessel; an intact lymphatic vessel or a vein was selected as a recipient. Feasibility and efficacy of the method were evaluated.
  
  
  RESULTS
  Among eight inguinal lymphorrhea patients, four patients with refractory lymphorrhea underwent NLS under local anesthesia. In all cases, a lymphatic vessel that caused an intractable lymphorrhea was successfully anastomosed to a recipient vessel (to an intact lymphatic vessel in one case, and to a venule in three cases), and the lymphorrhea was completely cured without lymphorrhea recurrence or lymphedema development. Treatment duration in NLS was significantly shorter than that in conservative treatments (5.0 ± 2.4 vs. 30.0 ± 8.1 days, P = 0.006).
  
  
  CONCLUSIONS
  Intraoperative ICG lymphography helps a surgeon to find lymphatic vessels in and near a lymphorrhea lesion, which allows secure and easier treatment for an intractable lymphorrhea with preservation of lymph drainage function.
authors.affiliation: Department of Plastic and Reconstructive Surgery, The University of Tokyo, Tokyo, Japan; Department of Plastic Surgery, Noda Hospital, Chiba, Japan. Electronic address: tyamamoto-tky@umin.ac.jp.
authors.forename: Takumi
authors.initials: T
authors.lastname: Yamamoto
authors.affiliation: Department of Plastic and Reconstructive Surgery, The University of Tokyo, Tokyo, Japan.
authors.forename: Hidehiko
authors.initials: H
authors.lastname: Yoshimatsu
authors.affiliation: Department of Plastic and Reconstructive Surgery, The University of Tokyo, Tokyo, Japan.
authors.forename: Isao
authors.initials: I
authors.lastname: Koshima
mesh_terms: D000328:Adult; D000368:Aged; D000714:Anastomosis, Surgical; D001706:Biopsy / Q000009:adverse effects; D004396:Coloring Agents; D005260:Female; D006119:Groin / Q000601:surgery; D006801:Humans; D007049:Iatrogenic Disease; D007208:Indocyanine Green; D042601:Lymphatic Vessels / Q000000981:diagnostic imaging / Q000293:injuries* / Q000601:surgery; D008220:Lymphography / Q000379:methods*; D008297:Male; D008853:Microscopy; D008866:Microsurgery / Q000379:methods*; D008875:Middle Aged; D013524:Surgical Flaps / Q000009:adverse effects; D016896:Treatment Outcome
chemical_list: D004396:Coloring Agents; D007208:Indocyanine Green
keywords: Anastomosis; Cyst; Indocyanine green (ICG); Lymphedema; Lymphorrhea; Supermicrosurgery