Technological Advances in Lymphatic Surgery: Bringing to Light the Invisible

Abstract

Summary: Lymphatic surgery has become an integral and flourishing component of the field of plastic surgery. The diversity of ongoing technological innovations in perioperative imaging, including intraoperative dyes and cameras, allows plastic surgeons to work at the supermicrosurgical level. This study aims to highlight innovations that have shaped and will continue to revolutionize the perioperative management of the lymphatic surgery patient in the future. As additional advances emerge, we need a systematic and objective way to evaluate the efficacy and clinical integration readiness of such technologies. Undoubtedly, these technologies will help lymphatic surgery trend toward increasing objectivity, which will be critical for continued evolution and advancement.

Meningeal Lymphatics: A Review and Future Directions From a Clinical Perspective

“…Techniques such as near-infrared imaging using indocyanine green (ICG) and nuclear lymphoscintigraphy allow for quantitative assessments lymphatic function, whereas MRI and computed tomography (CT) methods may be used for high-resolution structural visualization of individual lymphatic vessels. 61…”

“…61,68 However, as often enhancement of both lymphatic vessels and surrounding superficial veins occurs, a drawback to this imaging technique is its inability to definitively isolate solely lymphatic vessels. 61,67,68 Computed tomography modalities used in lymphatic imaging include single-photon emission CT, as well as CT-Lymphography. 61 Single-photon emission CT has been shown to provide preoperative value in precise localization of lymphatic vessels and nodes, whereas CT-Lymphography, though it does expose the patient to radiation, provides three-dimensional (3D) imaging of the lymphatic system, allowing for visualization of smaller lymphatic channels than other imaging techniques used, down to 0.7 to 1.2 nm in diameter.…”

“…Advancements in real-time, intraoperative lymphatic mapping and visualization technologies have made localization and isolation of these ultrafine lymphatic vessels possible, making them accessible for supermicrosurgical manipulation. 60,61 While there remains much to be studied regarding meningeal lymphatic vessels in humans prior to even elucidating their role in human disease processes, the ever-advancing sophistication of lymphatic imaging techniques today may assist in research and education regarding their anatomy and function in humans. Techniques such as near-infrared imaging using indocyanine green (ICG) and nuclear lymphoscintigraphy allow for quantitative assessments lymphatic function, whereas MRI and computed tomography (CT) methods may be used for high-resolution structural visualization of individual lymphatic vessels.…”

“…Techniques such as near-infrared imaging using indocyanine green (ICG) and nuclear lymphoscintigraphy allow for quantitative assessments lymphatic function, whereas MRI and computed tomography (CT) methods may be used for high-resolution structural visualization of individual lymphatic vessels. 61 Indocyanine green lymphangiography uses a subcutaneously injected, near-infrared fluorescent tracer to provide continuous, safe, and minimally invasive stain and radiation-free mode of lymphatic imaging. [61][62][63][64] Observation of ICG flow rate allows for functional assessment of lymphatic flow and has been used successfully for visualization of vessels as deep as 2 cm from the body surface.…”

“…61 Indocyanine green lymphangiography uses a subcutaneously injected, near-infrared fluorescent tracer to provide continuous, safe, and minimally invasive stain and radiation-free mode of lymphatic imaging. [61][62][63][64] Observation of ICG flow rate allows for functional assessment of lymphatic flow and has been used successfully for visualization of vessels as deep as 2 cm from the body surface. 61,65 Continuous imaging capability clearly discriminates lymphatic vessels from surrounding vasculature, as rapid dye dispersal ensues if uptake into venous channels occurs.…”