The use of integrated indocyanine green fluorescence microscope camera for intraoperative lymphography of supermicrosurgery.

INTRODUCTION: Supermicrosurgical lymphaticovenular anastomosis (LVA) toward becoming a treatment alternative for treatment and for surgical management of refractory lymphedema. Effective LVA requires supermicrosurgical systems to detect and anastomose lymphatic vessels, as they have a small vessel gauge measuring less than 0.5 mm.

METHOD: The antro- and retrograd deep LVAs were performed with the combination of superior-edge-of-the-knee incision method and ventral ankle joint incision method. The direction of lymphatic flow and lymphatic vessels were evaluated intraoperatively with OPMI Pentero Infrared 900 microscope. In postoperative conditions, all 10 patients had undergone intensive Manual Lymphatic Drainage (MLD) and compression therapy.

RESULTS: Total 29 LVAs and 16 skin incisions were performed with intraoperative microscopic ICG lymphography on 10 lower limbs. No lymphatic vessel was detected in one patient at superior-edge-of-the-knee incision. 1 of 29 LVAs showed no patency and 2 of 29 LVAs showed lower patency in intraoperative ICG lymphography. All patients showed reduction in the lymphedema clearly and softer tissues could also be found in postoperative stages.

CONCLUSION: Intraoperative microscope integrated with ICG fluorescence camera can takes shorter time for a lymphatic supermicrosurgeon to discover and dissect deeper lymphatic collector and evaluate anastomosis patency. Manual Lymphatic Drainage and compression therapy should start in early postoperative stages.