Objective
Lymphedema is a debilitating disease that impairs a patient’s quality of life. Though lymphovenous anastomosis (LVA) can cure lymphedema, successful LVAs rely on the precise identification of lymph vessels. This study aimed to assess the use of a near-infrared camera-integrated operating microscope for the preoperative mapping of lymphatic vessels and evaluate the outcome of LVAs in patients with limb secondary lymphedema.
Methods
We retrospectively reviewed patients with secondary unilateral lymphedema who underwent LVA surgery with lymph vessels identified using a near-infrared camera-integrated operating microscope (Moller 3-1000; Möller-Wedel Optical GmbH, Wedel, Germany) between 2020 and 2021. The lymph vessels identified by near-infrared fluorescence lymphography, diameter of vessels used for anastomosis, anastomosis configuration and perioperative limb circumferences were recorded.
Results
Overall, thirty-five LVAs were performed in six secondary lymphedema patients, with a mean number of 5.8 LVAs per limb. The anastomotic configurations were end-to-end in 26 LVAs, side-to-end in two LVAs, end-to-side in seven LVAs. The diameter of the lymph vessels ranged from 0.3 to 0.9 mm (0.62±0.18 mm), and that of the vein ranged from 0.4 to 1.2 mm (0.75±0.21 mm). Lymphedema index and estimated limb volume indicated a postoperative decrease in edema.
Conclusions
A near-infrared camera-integrated operating microscope is useful for the preoperative identification of functional lymph vessels. Microsurgical LVAs can be performed using an integrated indocyanine green (ICG) camera without an independent ICG detector.