Near-infrared illumination system-integrated microscope for supermicrosurgical lymphaticovenular anastomosis

Abstract

Lymphatic supermicrosurgery, lymphaticovenular anastomosis (LVA), is becoming a treatment option for progressive lymphedema with its effectiveness and minimal invasiveness. It is important to detect and anastomose large functional lymphatic vessels for LVA surgery. This study aimed to evaluate usefulness of a near-infrared illumination system-integrated microscope for lymphatic supermicrosurgery. We performed LVA on 12 lower extremity lymphedema (LEL) patients with or without intraoperative microscopic indocyanine green (ICG) lymphography guidance. An operating microscope equipped with an integrated near-infrared illumination system (OME-9000; Olympus, Tokyo, Japan) was used for intraoperative microscopic ICG lymphography guidance. Feasibility, anastomosis patency, and treatment effect of the method were evaluated. Forty LVAs were performed (24 LVAs with intraoperative microscopic ICG lymphography-guidance on 7 limbs, and 16 LVAs without the guidance on 5 limbs). Lymphatic vessels were enhanced by intraoperative microscopic ICG lymphography in 11 of 12 skin incision sites. Time required for detection and dissection of lymphatic vessels in cases with intraoperative microscopic ICG lymphography guidance was significantly shorter than that in cases without the guidance (2.3 ± 1.7 min vs. 6.5 ± 4.0 min, P = 0.010). There was no statistically significant difference in LEL index reduction between cases with and without intraoperative microscopic ICG lymphography guidance (18.3 ± 5.5 vs. 15.0 ± 5.5, P = 0.337). Intraoperative microscopic ICG lymphography visualized lymphatic vessels, which helps a lymphatic supermicrosurgeon to find and dissect lymphatic vessels earlier.