Augmented reality of indocyanine green fluorescence in simplified lymphovenous anastomosis in lymphatic surgery
Issue title: Selected papers of the 38th Conference of the German Society for Clinical Microcirculation and Hemorheology, 21-23 November 2019, Braunschweig, Germany
Guest editors: P. Wiggermann, A. Krüger-Genge and F. Jung
Affiliations: [a] University Center of Plastic-, Aesthetic, Hand- and Reconstructive Surgery, University of Regensburg, Regensburg, Germany
| [b] Division of Plastic Surgery and Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Jacksonville, FL, USA
Correspondence:
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Corresponding author: Thiha Aung, MD, University Center of Plastic-, Aesthetic, Hand- and Reconstructive Surgery, University of Regensburg, Franz-Josef-Strauß-Allee 11, Regensburg, Germany. E-mail: [email protected].
Abstract: BACKGROUND:A physiological and minimal invasive form of surgery with minimal risk to treat lymphedemas is the so-called supermicrosurgical lymphovenous anastomosis (LVA) where a lymph vessel is connected with a venule. METHODS:30 patients (between 2018 and 2019) with secondary upper extremity lymphedema refractory to conservative therapy (manual lymph drainage and compression therapy were operated using the “simplified lymphovenous anastomosis” method). For the assessment of lymphatic supermicrosurgery, an operating microscope in which a near-infrared illumination system is integrated (Leica M530 OHX with glow technology ULT530, Leica Microsystems) and the IC-FlowTM Imaging System(Diagnostic Green)/Visionsense System (Medtronic) together with a ZEISS S8 microscope was used. Augmented reality intraoperative indocyanin green (ICG) lymphography-navigated modified “simplified lymphovenous anastomosis” were performed on the Leica microscope. All patients were informed about Off-label-use of ICG lymphography. RESULTS:57 LVAs were performed with modified “simplified lymphovenous anastomosis” lymphography-guidance on 30 upper extremities. All patients showed good patency after lymphovenous anastomosis. CONCLUSIONS:Supermicrosurgery in the case of LVA is minimally invasive, highly effective, and shows a very low complication rate. The surgeon/equipment-related factors restrict the pratice of LVA, and its effectiveness limited by technical constraints.
