Intraoperative identification and definition of “functional” lymphatic collecting vessels for supermicrosurgical lymphatico‐venous anastomosis in treating lymphedema patients

Yang, Johnson Chia‐Shen; Wu, Shao-Chun; Chiang, Min-Hsien; Lin, Wei-Che; Hsieh, Ching‐Hua

doi:10.1002/jso.25014

Cited by 41 publications

(38 citation statements)

References 47 publications

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“…ICG lymphography has limitation in detecting lymphatic vessels intraoperatively. 26,31,32 Yang et al 33 reported that 36.1% of lymphatic vessels were not enhanced intraoperatively by ICG fluorescence. Detection rate of lymphatic vessels in real-time ICG videolymphography in this study was 86.7%.…”

Section: Discussionmentioning

confidence: 99%

Real-time Indocyanine Green Videolymphography Navigation for Lymphaticovenular Anastomosis

Seki

Kajikawa

Yamamoto

et al. 2019

Plastic and Reconstructive Surgery - Global Open

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Summary: Indocyanine green (ICG) lymphography is a useful imaging modality for evaluation of lymphedema and detection of lymphatic vessels. It also allows us to ensure patency of the anastomosed vessels intraoperatively. However, strong light from the operating microscope usually disturbs ICG fluorescence imaging. Only some built-in ICG camera systems with specific operating microscopes make real-time ICG lymphography possible in lymphaticovenular anastomosis (LVA). We applied a new high-resolution ICG videolymphography system, which is separated from the operating microscope. Because the system can divide near-infrared fluorescence light of ICG from visible light of the operating microscope, real-time ICG videolymphography-navigated LVA under operating microscope illumination is possible regardless types of operating microscopes. The study involved 10 patients with upper extremity lymphedema characterized by International Society of Lymphology stage 2 and treated by 3 lymphaticovenular anastomoses at the forearm (30 lymphaticovenular anastomoses incorporating 30 lymphatic vessels) under real-time ICG videolymphography. The rate of intraoperative detection of lymphatic vessels using real-time ICG videolymphography was 86.7% (0.25–0.85 mm in diameter), and that of lymph flow through the lymphaticovenular anastomoses was 76.7%. None of lymphatic vessels and no flow were detected under the microscope light by means of another non-built-in ICG lymphography camera. Real-time ICG videolymphography in LVA is beneficial, because the surgeon could find lymphatic vessels easily by checking dual images of original view and ICG fluorescent view and ensure accuracy of the LVA in a suture by a suture without any pauses of the surgical procedures.

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Section: Discussionmentioning

confidence: 99%

Real-time Indocyanine Green Videolymphography Navigation for Lymphaticovenular Anastomosis

Seki

Kajikawa

Yamamoto

et al. 2019

Plastic and Reconstructive Surgery - Global Open

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“…Since its introduction in clinical practice in the last decade, it has played a crucial role in the understanding and management of CLAs. If a specific area of obstruction is identified via MRL, then a lymphaticovenous anastomosis can be attempted in certain cases with significant improvement in symptoms. In these patients, medical therapy alone will not be enough until the interrupted flow is restored.…”

Section: Recommendationsmentioning

confidence: 99%

Multidisciplinary guidelines for initial evaluation of complicated lymphatic anomalies—expert opinion consensus

Iacobas

Adams

Pimpalwar

et al. 2019

Pediatric Blood & Cancer

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Objective Complicated lymphatic anomalies (CLAs) are chronic, progressive, and debilitating conditions that share clinical features, yet key elements for optimal evaluation and management have not been established. We aimed to formulate expert opinion consensus‐based guidelines for comprehensive evaluation of CLAs. Study Design Patient support groups dedicated to CLAs organized an international conference for vascular anomaly experts from 16 specialties to address the objective. Participants received a set of questions before the meeting and reviewed the literature. Data extracted from international lymphatic anomaly registries were presented and the group separated for panel discussions during the conference. The recommendations achieving consensus within the panel were presented to the entire audience. Open debate occurred until majority approval was achieved. Results The expert group was composed of 52 physicians who defined the clinical elements required to evaluate and diagnose a CLA. The radiology panel established the preferred anatomical and functional imaging methods for diagnosis and the elements required to be described during interpretation. Two medical panels compiled the metabolic and hematologic tests at diagnosis and also recommended functional studies. The surgical group recommended precautions for biopsy and the pathology panel provided biopsy specimen processing guidelines. Conclusions Patients with CLAs require a comprehensive and targeted diagnostic plan for appropriate management, prevention of complications, and conservation of resources. As this population is managed by diverse medical and surgical specialties, we offer an expert multidisciplinary consensus‐based opinion on the current literature and on data extracted from international lymphatic anomaly registries.

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“…The use of ICG lymphangiography has revolutionized the field of lymphatic surgery as the ICG is absorbed into the lymphatic system allowing detection of the lymphatic vessels with infrared imaging devices such as the Photodynamic Eye (PDE, Hamamatsu Photonics, Japan) or SPY Elite (Stryker Inc., Kalamazoo, MI). A variety of staging criteria has emerged based on ICG lymphangiography which traditionally has dictated the modality of treatment . Once the lymphatic vessels are identified, an anastomosis can be performed creating a shunt to allow the lymphatic fluid to drain into the systemic circulation.…”

Section: Lymphedema Supermicrosurgerymentioning

confidence: 99%

Advancements in imaging technology for microvascular free tissue transfer

Chang¹,

Chu

Chang

2018

Journal of Surgical Oncology

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The use of preoperative imaging has become routine for many reconstructive microsurgeons to help localize perforators for planning of microvascular free flaps. However, with advancements in imaging technology, perforator mapping represents only one potential benefit as virtual planning and medical modeling, and flap tissue perfusion are also rapidly becoming commonplace and the standard of care for many surgeons who perform high-volume free flap reconstruction for the breast, head and neck, torso, and the extremities.

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Intraoperative identification and definition of “functional” lymphatic collecting vessels for supermicrosurgical lymphatico‐venous anastomosis in treating lymphedema patients

Abstract: Lymphatic flow-positive but non-ICG enhanced LCVs, should also be considered as functional, thereby maximizing the number of functional LCVs for LVA.

Cited by 41 publications

References 47 publications

Real-time Indocyanine Green Videolymphography Navigation for Lymphaticovenular Anastomosis

Real-time Indocyanine Green Videolymphography Navigation for Lymphaticovenular Anastomosis

Multidisciplinary guidelines for initial evaluation of complicated lymphatic anomalies—expert opinion consensus

Advancements in imaging technology for microvascular free tissue transfer

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