Lymphovenous Anastomosis for the Treatment of Thoracic Duct Lesion

Abstract

BACKGROUND Chylous leak is an uncommon complication after head and neck surgery and typically results from a lesion of the thoracic duct (TD). Beside conservative treatment, different minimally invasive and surgical procedures exist, of which almost all lead to a total closure of the TD. METHODS We report on a rare case of microsurgical lymphovenous anastomosis to treat a TD lesion. An additional systematic review on surgical procedures to treat TD lesions with special attention to lymphovenous anastomoses was performed according to the PRISMA guidelines. RESULTS A 52-year-old patient with a chylous fistula after modified radical neck dissection was successfully treated by a lymphovenous anastomosis of the TD and external jugular vein with additional coverage by sternocleidomastoid muscle flap. The patient showed a complete resolution of chylous leak with an uneventful postoperative course.The systematic search of literature yielded 684 articles with 4 case reports on lymphovenous anastomosis in chylous leak with a high success rate. Other surgical techniques include transcervical, thoracoscopic, or video-assisted thoracoscopic TD ligation, either alone or combined with a local muscle flap. CONCLUSIONS Lymphovenous anastomosis of the TD is a feasible and safe technique allowing for treatment of cervical TD lesions, especially if minimally invasive procedures fail. Compared with other techniques, lymphatic circulation can successfully be maintained.

Exploring the learning curve of a new robotic microsurgical system for microsurgery

“…We performed LVAs of the thoracic duct in patients with chylous leaks or protein-losing enteropathy due to congenital malformations of the central lymphatic system, which usually requires to perform microsurgery deep within the thoracic or abdominal cavities. Based on our surgical experience, the Symani Surgical System® would have been of noticeable help in performing these complex surgeries in a not easily accessible location 3 . Additional applications of the robot for such surgeries will be further explored by our group.…”

Early Experience Using a New Robotic Microsurgical System for Lymphatic Surgery

“… 1 , 2 In reconstructive surgery, micro- and super microsurgery are the key elements that have enabled surgeons to treat complex diseases. 3 , 4 …”

“…1,2 In reconstructive surgery, micro-and super microsurgery are the key elements that have enabled surgeons to treat complex diseases. 3,4 Although the da Vinci robot was originally conceived for endoscopic interventions, its use in microsurgery remained restricted due to several limitations. 5,6 The MUSA robot (Microsure) was introduced in 2021 using fixed joysticks, which are connected to a scaffold and standard microsurgical instruments.…”

Robotik in der plastischen Chirurgie

“…Abb. 3) durchgeführt haben [10,11]. Im Gegensatz zu einer interventionell-radiologischen Embolisation ermöglicht dies eine Rekonstruktion des physiologischen Lymphabflusses [6][7][8].…”

“…In den vergangenen Jahren findet die rekonstruktive Lymphchirurgie zunehmend auch bei Kindern mit Lymphödem oder zentralen lymphatischen Anomalien Anwendung [11,15,20]. So haben wir kürz-…”