Supermicrosurgery for patients with lymphedema offers minimally invasive option that can vastly improve quality of life

surgeons perform supermicrosurgery on patients with lymphedema

by Celia Spell

As a component of the immune system and a complement to the circulatory system, the lymphatic system drains excess fluid from the body’s tissues and filters out foreign particles to protect against infection.

Cancer and cancer treatment can block and alter the lymphatic system, resulting in swelling of the limbs and tight or leathery skin in the affected area. Known as lymphedema, this condition can also impact someone’s day-to-day life by causing flu-like symptoms and fatigue as well as pain and limited movement in the swollen area.

Gabriel Klein, M.D., is a plastic surgeon at MUSC Health who specializes in microvascular reconstruction. He points to lymphaticovenous anastomosis, or LVA, as a minimally invasive option for patients with lymphedema. This supermicrosurgery, so named due to the veins’ minute size, allows surgeons to bypass the damaged area of a patient’s lymphatic system by connecting lymphatic vessels to veins and creating a new pathway for lymph to travel through the body.

“Lymphedema is an incredibly life-limiting illness,” Klein said. “But we can intervene with new-found techniques like this supermicrosurgery.”

surgeons look into the robot to perform surgery
Gabriel Klein, M.D., and Isis Scomacao, M.D., perform supermicrosurgery for lymphedema. Credit: Scott Garrand

According to Klein, microsurgery involves vessels under 2 millimeters, but since lymphatic vessels are even smaller, at less than 0.8 millimeters, the procedure is considered a supermicrosurgery. An anastamosis is the connection of two branching pathways, such as streams, leaf veins or blood vessels. And an LVA connects lymphatic and blood vessels under high magnification.

Creating anastomoses has been growing as a surgical technique over the last 5-10 years, Klein said, but most centers don’t offer this particular procedure yet. And in South Carolina, MUSC is the only option for it currently.

Before performing an LVA, plastic surgeons like Klein inject dye into the affected limb of the patient and then perform imaging in the clinic immediately after injection and again 6 hours later to pinpoint exactly where the system is clogged or damaged.

Once the patient is under anesthesia, Klein maps the lymphatic vessels in the limb using lymphography and then uses a vein finder to locate nearby veins. Working through tiny incisions, he then connects the lymphatic vessels to these functioning veins and vessels using a proven method known as the octopus technique. The LVA procedure often includes 3-6 small incisions for each connection, and the patient is able to go home the same day.

Symptoms for patients often improve over the next few weeks, and Klein says they’re always pleasantly surprised with the difference.

“I think what makes this surgery so unique is that it can solve what ends up being a very big problem with very small incisions and minimal dissection,” Klein said. “A lot of the patients who come in are pleasantly surprised with how little they have to suffer for such a major improvement in their lifestyle.”