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Minimally Invasive Lymphatic Supermicrosurgery (MILS): Indocyanine Green Lymphography-Guided Simultaneous Multisite Lymphaticovenular Anastomoses via Millimeter Skin Incisions

Yamamoto, Takumi MD; Narushima, Mitsunaga MD; Yoshimatsu, Hidehiko MD; Seki, Yukio MD; Yamamoto, Nana MD; Oka, Aiko MD; Hara, Hisako MD; Koshima, Isao MD

doi: 10.1097/SAP.0b013e3182605580

Among various surgical treatments, lymphaticovenular anastomosis (LVA), which bypasses congested lymph into venous circulation, is the least invasive surgical treatment. However, it usually entails skin incisions of around 3 cm, and operation time of around 4 hours. With multiple supermicrosurgeons under guidance of indocyanine green lymphography, LVAs can be simultaneously performed under local anesthesia within approximately 2 hours via small skin incisions with length less than 1 cm, allowing minimally invasive lymphatic supermicrosurgery (MILS). We performed MILS on 11 limbs of compression-refractory peripheral lymphedema cases. Length of skin incision for LVA ranged from 1 to 9 mm. Average operation time was 1.82 hours. Of the11 limbs, 10 showed postoperative volume reduction. Indocyanine green lymphography clearly visualizes superficial lymph flows, which helps us to decide precise skin incision sites and find lymphatic vessels in LVA surgery, shortening skin incision length and operation time. Minimally invasive lymphatic supermicrosurgery can serve as the most reasonable treatment of compression-refractory peripheral lymphedema.

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From the Department of Plastic and Reconstructive Surgery, Graduate School of Medicine, University of Tokyo, Bunkyo-ku, Tokyo, Japan.

Received February 14, 2012, and accepted for publication, after revision, May 14, 2012.

Presented in part at the 14th International Course on Perforator Flap on October 15th, 2011 in Seoul, Korea.

Conflicts of interest and sources of funding: none declared.

Reprints: Takumi Yamamoto, MD, Department of Plastic and Reconstructive Surgery, Graduate School of Medicine, the University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan. E-mail:

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