Division of Plastic and Reconstructive Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan; Department of Surgery, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan.
Department of Plastic and Reconstructive Surgery, Center Hospital of National Center for Global Health and Medicine, Tokyo, Japan.
J Vasc Surg Venous Lymphat Disord. 2023 Jan;11(1):161-166. doi: 10.1016/j.jvsv.2022.06.012. Epub 2022 Aug 5.
Lymphedema is a debilitating disease that impairs a patient's quality of life. Although lymphovenous anastomosis (LVA) can cure lymphedema, successful LVAs rely on the precise identification of the lymph vessels. In the present study, we assessed the use of a near-infrared camera-integrated operating microscope for preoperative mapping of the lymphatic vessels and evaluated the outcome of LVAs in patients with secondary lymphedema of a limb.
We retrospectively reviewed patients with secondary unilateral lymphedema who had undergone LVA surgery with the 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 using near-infrared fluorescence lymphography, diameter of the vessels used for anastomosis, anastomosis configuration, and perioperative limb circumference were recorded.
Overall, 35 LVAs were performed in six patients with secondary lymphedema, with a mean number of 5.8 LVAs per limb. The anastomotic configurations were end-to-end in 26 LVAs, side-to-end in 2 LVAs, and end-to-side in 7 LVAs. The diameter of the lymph vessels ranged from 0.3 to 0.9 mm (mean, 0.62 ± 0.18 mm) and that of the vein from 0.4 to 1.2 mm (mean, 0.75 ± 0.21 mm). The changes in the lymphedema index and estimated limb volume indicated a postoperative decrease in edema.
We found a near-infrared camera-integrated operating microscope useful for the preoperative identification of functional lymph vessels. Our results have shown that microsurgical LVAs can be performed using an integrated indocyanine green camera without an independent indocyanine green detector.
淋巴水肿是一种使人虚弱的疾病，会降低患者的生活质量。尽管淋巴静脉吻合术（LVA）可以治愈淋巴水肿，但成功的 LVA 依赖于对淋巴管的准确识别。在本研究中，我们评估了近红外相机集成手术显微镜在术前淋巴管定位中的应用，并评估了该技术在肢体继发性淋巴水肿患者中进行 LVA 的效果。
我们回顾性分析了 2020 年至 2021 年间使用近红外相机集成手术显微镜（德国 Wedel 的 Möller-Wedel Optical GmbH 公司生产的 Moller 3-1000）识别淋巴管后行 LVA 手术的单侧继发性淋巴水肿患者。记录了使用近红外荧光淋巴造影术识别的淋巴管、吻合血管的直径、吻合方式和围手术期肢体周径。
共有 6 例继发性淋巴水肿患者接受了 35 次 LVA，平均每条肢体进行 5.8 次 LVA。吻合方式为端对端吻合 26 次，端侧吻合 2 次，侧侧吻合 7 次。淋巴管的直径为 0.3 至 0.9mm（平均 0.62 ± 0.18mm），静脉直径为 0.4 至 1.2mm（平均 0.75 ± 0.21mm）。淋巴水肿指数和估计肢体体积的变化表明术后水肿减轻。
我们发现近红外相机集成手术显微镜有助于术前识别功能性淋巴管。我们的结果表明，使用集成吲哚菁绿相机可以进行显微 LVA，而无需独立的吲哚菁绿探测器。
