The International Center for Lymphedema, Hiroshima University Hospital, Hiroshima, Japan.
The International Center for Lymphedema, Hiroshima University Hospital, Hiroshima, Japan.
J Plast Reconstr Aesthet Surg. 2019 Aug;72(8):1334-1339. doi: 10.1016/j.bjps.2019.03.038. Epub 2019 Apr 11.
A drawback of multiple lymphaticovenular anastomoses (LVAs) is the need for at least two microsurgeons and the same number of microscopes. In practice, many hospitals find it difficult to access such resources. We have developed a novel line production system (LPS) to address this problem. We assessed whether or not the LPS is better than the conventional dual microscope (DM) system when performing multiple LVAs.
An LPS group, wherein a novice microsurgeon used loupes to dissect lymphatics and an expert microsurgeon used a microscope to perform the LVAs, and a DM (control) group, wherein the surgeons used microscopes to perform the LVAs. We recorded the lymphatic detection rate through the loupes and the diameter of the detected lymphatics. We also investigated the impact of using the LPS by comparing the number and quality of LVAs and improvement in lymphedema between the study groups.
The mean lymphatic detection rate was 81%±15.60%, and the mean size of lymphatics was 0.44 ± 0.12 mm in the LPS. The number of LVAs/h in LPS was significantly higher than that in DM (2.15 ± 0.20 vs. 1.38 ± 0.17; p < 0.01). The number of successful LVAs/h in LPS was significantly higher than that in the DM (2.08 ± 0.22 vs. 0.84 ± 0.14; P < 0.01). Mean rate of improvement in LEL index was significantly higher than that in DM (9.36 ± 1.85 vs. 6.93 ± 1.73; P < 0.01).
The number and quality of the LVAs increase using the LPS, which leads to further improvement in lymphedema, with fewer microscopes and microsurgeons and a shorter operating time.
多次淋巴管-静脉吻合术（LVA）的一个缺点是至少需要两名显微外科医生和数量相同的显微镜。在实践中，许多医院发现很难获得这些资源。我们开发了一种新的流水线生产系统（LPS）来解决这个问题。我们评估了在进行多次 LVA 时，LPS 是否优于传统的双显微镜（DM）系统。
一组使用手术放大镜进行淋巴管解剖的新手显微外科医生和一组使用显微镜进行 LVA 的专家显微外科医生组成 LPS 组，另一组使用显微镜进行 LVA 的 DM（对照组）。我们记录了通过手术放大镜检测到的淋巴管的检出率和检测到的淋巴管的直径。我们还通过比较研究组之间 LVA 的数量和质量以及淋巴水肿的改善情况，研究了使用 LPS 的影响。
LPS 组的平均淋巴管检出率为 81%±15.60%，检出淋巴管的平均直径为 0.44±0.12mm。LPS 组的 LVA/h 数量明显高于 DM 组（2.15±0.20 vs. 1.38±0.17；p<0.01）。LPS 组的成功 LVA/h 数量明显高于 DM 组（2.08±0.22 vs. 0.84±0.14；P<0.01）。LEL 指数的平均改善率明显高于 DM 组（9.36±1.85 vs. 6.93±1.73；P<0.01）。
使用 LPS 可增加 LVA 的数量和质量，从而进一步改善淋巴水肿，同时减少显微镜和显微外科医生的数量，并缩短手术时间。
