Supermicrosurgical Suture-Stent Technique for A Lymphaticovenular Bypass.

Ryo Karakawa,Yuma Fuse,Tomoyuki Yano,Hidehiko Yoshimatsu,Keisuke Kamiya

doi:10.3390/jcm10122595

Abstract

Background: Lymphaticovenular anastomosis (LVA) is a challenging procedure and requires a sophisticated supermicrosurgical technique. The aim of this study was to evaluate and establish a discrete supermicrosurgical anastomosis method using the “suture-stent technique”. Methods: Forty-eight LVA sites of twenty patients with lower extremity lymphedema who had undergone LVA between July 2020 and January 2021 were included in this study. LVA was performed with the conventional technique or with the suture-stent technique. The patency of the anastomoses was evaluated using an infrared camera system intraoperatively. The success rate on the first try and the final success rate for each group were compared. Results: After full application of the exclusion criteria, 35 LVAs of 16 patients including 20 limbs were included in the analysis. The ratio of good patency findings after anastomosis in the suture-stent technique group was 100%. The incidences of leakage or occlusion on the first try were statistically greater in the conventional technique group (29.4%) than in the suture-stent technique group (0%) (p = 0.0191). All anastomoses achieved good patency in the final results. Conclusion: With its minimal risk of catching the back wall during the anastomosis, the suture-stent technique can be considered an optimal anastomosis option for LVA.

Highlights

Lymphedema is a debilitating condition caused by a failure of the lymphatic drainage system, and it is characterized by swelling and fibroadipose tissue deposition in the extremities [1,2]
After the introduction of the supermicrosurgical technique for Lymphaticovenular anastomosis (LVA), which uses lymphatics and venules smaller than 0.8 mm, by Koshima et al, many studies have reported the successful outcome of performing LVA in lymphedema patients with various modifications [4,5,6,7,8,9,10]
LVA is still a challenging procedure for microsurgeons and requires a sophisticated supermicrosurgical technique because thin-walled lymphatic vessels, whose diameter is usually smaller than 0.8 mm, are difficult to detect and anastomose [11]

Summary

Introduction

Lymphedema is a debilitating condition caused by a failure of the lymphatic drainage system, and it is characterized by swelling and fibroadipose tissue deposition in the extremities [1,2]. After the introduction of the supermicrosurgical technique for LVA, which uses lymphatics and venules smaller than 0.8 mm, by Koshima et al, many studies have reported the successful outcome of performing LVA in lymphedema patients with various modifications [4,5,6,7,8,9,10]. LVA is still a challenging procedure for microsurgeons and requires a sophisticated supermicrosurgical technique because thin-walled lymphatic vessels, whose diameter is usually smaller than 0.8 mm, are difficult to detect and anastomose [11]. The aim of this study was to evaluate and establish a discrete supermicrosurgical anastomosis technique using the “suture-stent technique” in LVA. The aim of this study was to evaluate and establish a discrete supermicrosurgical anastomosis method using the “suture-stent technique”

Objectives

Methods

Results

Conclusion