The development of surgical treatment of lymphedema has been a challenging endeavor.Various surgical modalities have been proposed,but the results are often unsatisfactory.The lymphaticovenous anastomosis(LVA)revoluti...The development of surgical treatment of lymphedema has been a challenging endeavor.Various surgical modalities have been proposed,but the results are often unsatisfactory.The lymphaticovenous anastomosis(LVA)revolutionized by Koshima et al.with the introduction of super microsurgery has gained traction in the treatment of lymphedema and has shown favorable results.However,super microsurgery requires excellent hand-eye coordination,meticulous tissue handling,dexterity,and operative flow,which are subject to multiple factors.Robot-assisted microsurgery(RAMS)has the potential to increase safety for clinicians and patients and create new possibilities in the field of super microsurgery.Therefore,plastic surgeons of the Maastricht University Medical Center(Maastricht,the Netherlands)teamed up with engineers from the Eindhoven University of Technology(Eindhoven,the Netherlands)and developed the first dedicated robotic platform for(super)microsurgery,the MUSA.The development of MUSA,from inception to the first clinical study in patients with lymphedema,has yielded promising results.This review aims to elucidate the development of the MUSA and its role in lymphatic surgery.展开更多
Aim:Although vascularized lymph node transplantation(VLNT)has gained recognition as an effective treatment option for lymphedema,no consensus on the timing of transplant with other lymphatic procedures has been establ...Aim:Although vascularized lymph node transplantation(VLNT)has gained recognition as an effective treatment option for lymphedema,no consensus on the timing of transplant with other lymphatic procedures has been established.The aim of this study is to describe our institutional experience with VLNT,including our staged approach and report postoperative outcomes.Methods:A retrospective review of patients who underwent VLNT for upper extremity lymphedema from May 2017 to April 2022 was conducted.Patients were divided into fat-or fluid-dominant phenotypes based on preoperative workup.Patients with a minimum of 12-month follow-up were included.Records were reviewed for demographic,intraoperative,and surveillance data.Results:Twenty-three patients underwent VLNT of the upper extremity during the study period,of which eighteen met the study criteria.Nine patients had fluid-dominant disease and nine patients had fat-dominant disease and had undergone prior debulking at our institution.Fluid-dominant patients demonstrated slight reductions in limb volume and hours in compression,and improvement in quality-of-life scores at twelve months.Fat-dominant patients who underwent prior debulking had a slight increase in limb volume without a change in hours of compression,and demonstrated improvements in quality-of-life scores in nearly all subdomains.Overall,17% of patients discontinued compression therapy entirely.Improvement in extremity edema was present in 83% of postoperative MRIs.Conclusion:VLNT had varying effects on limb measurements while reliably improving quality-of-life and allowing for the potential of discontinuing compression.Utilizing a staged approach wherein debulking is performed upfront may be particularly beneficial for patients with fat-dominant disease.展开更多
The recent development of robotic-assisted microsurgery and supermicrosurgery has raised great expectations to support some of the most demanding microsurgical procedures,which are applied in lymphatic reconstructive ...The recent development of robotic-assisted microsurgery and supermicrosurgery has raised great expectations to support some of the most demanding microsurgical procedures,which are applied in lymphatic reconstructive surgery to restore lymphatic vascular integrity and treat lymphedema.Procedures such as the establishment of lymphovenous anastomosis(LVA),the harvest of lymph nodes from anatomic locations that reduce donor-side morbidity and the transplantation of the vascularized lymph node flaps(VLNT)present procedures necessitating extreme precision and dexterity in often difficult-to-reach areas,thus pushing the physical limitations of the performing microsurgeon.Despite being limited in number,recent preclinical and clinical studies of independent groups using different robotic systems demonstrate the feasibility of robotic technology to perform supermicrosurgical procedures successfully.The robotic assistance offers unparalleled precision,refining the surgical techniques and minimizing potential side effects,with clinical outcomes comparable to the conventional techniques.Although the relative disadvantages of robotic assistance mostly appear to be related to adequate training and the prolonged learning curve,the technology promises to revolutionize the field of supermicrosurgery and improve the clinical outcomes of lymphatic reconstructive surgery.展开更多
MAIN TEXT Dear Sir,I have read with great interest the article“Vascularized omental tissue transfer for the treatment of lymphedema:a review”published in Plast Aesthet Res 2023[1].The review provides a comprehensive...MAIN TEXT Dear Sir,I have read with great interest the article“Vascularized omental tissue transfer for the treatment of lymphedema:a review”published in Plast Aesthet Res 2023[1].The review provides a comprehensive overview of vascularized omental tissue transfer(VOLT)for lymphedema treatment,a subject of considerable clinical importance.I believe it is appropriate to particularly commend the authors for their detailed analysis of techniques and various surgical options.The discussion on the immunological properties of the omentum and its value as a donor site for lymph nodes was notably insightful.Significant points from this review include the efficacy of VOLT in reducing the volume of limbs with lymphedema and related symptoms,and the insight into the use of robotic surgery,which opens new perspectives on harvesting techniques.I would like to congratulate the authors for their meticulous research because a better level of evidence is needed in the field of lymphedema surgery.This article not only enriches our understanding of lymphedema and its treatment options but also offers a valuable guide for physicians dealing with this debilitating complication.At our center,we perform vascularized omental lymph node transfer for the treatment of limb lymphedema,mainly after gynecological cancer[2,3].展开更多
文摘The development of surgical treatment of lymphedema has been a challenging endeavor.Various surgical modalities have been proposed,but the results are often unsatisfactory.The lymphaticovenous anastomosis(LVA)revolutionized by Koshima et al.with the introduction of super microsurgery has gained traction in the treatment of lymphedema and has shown favorable results.However,super microsurgery requires excellent hand-eye coordination,meticulous tissue handling,dexterity,and operative flow,which are subject to multiple factors.Robot-assisted microsurgery(RAMS)has the potential to increase safety for clinicians and patients and create new possibilities in the field of super microsurgery.Therefore,plastic surgeons of the Maastricht University Medical Center(Maastricht,the Netherlands)teamed up with engineers from the Eindhoven University of Technology(Eindhoven,the Netherlands)and developed the first dedicated robotic platform for(super)microsurgery,the MUSA.The development of MUSA,from inception to the first clinical study in patients with lymphedema,has yielded promising results.This review aims to elucidate the development of the MUSA and its role in lymphatic surgery.
基金partially supported by the National Heart,Lung,and Blood Institute of the National Institutes of Health(https://www.nhlbi.nih.gov/)under Award Number R01HL157991sponsored by the 2022 JOBST Lymphatic Research Grant awarded by the Boston Lymphatic Symposium,Inc.
文摘Aim:Although vascularized lymph node transplantation(VLNT)has gained recognition as an effective treatment option for lymphedema,no consensus on the timing of transplant with other lymphatic procedures has been established.The aim of this study is to describe our institutional experience with VLNT,including our staged approach and report postoperative outcomes.Methods:A retrospective review of patients who underwent VLNT for upper extremity lymphedema from May 2017 to April 2022 was conducted.Patients were divided into fat-or fluid-dominant phenotypes based on preoperative workup.Patients with a minimum of 12-month follow-up were included.Records were reviewed for demographic,intraoperative,and surveillance data.Results:Twenty-three patients underwent VLNT of the upper extremity during the study period,of which eighteen met the study criteria.Nine patients had fluid-dominant disease and nine patients had fat-dominant disease and had undergone prior debulking at our institution.Fluid-dominant patients demonstrated slight reductions in limb volume and hours in compression,and improvement in quality-of-life scores at twelve months.Fat-dominant patients who underwent prior debulking had a slight increase in limb volume without a change in hours of compression,and demonstrated improvements in quality-of-life scores in nearly all subdomains.Overall,17% of patients discontinued compression therapy entirely.Improvement in extremity edema was present in 83% of postoperative MRIs.Conclusion:VLNT had varying effects on limb measurements while reliably improving quality-of-life and allowing for the potential of discontinuing compression.Utilizing a staged approach wherein debulking is performed upfront may be particularly beneficial for patients with fat-dominant disease.
文摘The recent development of robotic-assisted microsurgery and supermicrosurgery has raised great expectations to support some of the most demanding microsurgical procedures,which are applied in lymphatic reconstructive surgery to restore lymphatic vascular integrity and treat lymphedema.Procedures such as the establishment of lymphovenous anastomosis(LVA),the harvest of lymph nodes from anatomic locations that reduce donor-side morbidity and the transplantation of the vascularized lymph node flaps(VLNT)present procedures necessitating extreme precision and dexterity in often difficult-to-reach areas,thus pushing the physical limitations of the performing microsurgeon.Despite being limited in number,recent preclinical and clinical studies of independent groups using different robotic systems demonstrate the feasibility of robotic technology to perform supermicrosurgical procedures successfully.The robotic assistance offers unparalleled precision,refining the surgical techniques and minimizing potential side effects,with clinical outcomes comparable to the conventional techniques.Although the relative disadvantages of robotic assistance mostly appear to be related to adequate training and the prolonged learning curve,the technology promises to revolutionize the field of supermicrosurgery and improve the clinical outcomes of lymphatic reconstructive surgery.
文摘MAIN TEXT Dear Sir,I have read with great interest the article“Vascularized omental tissue transfer for the treatment of lymphedema:a review”published in Plast Aesthet Res 2023[1].The review provides a comprehensive overview of vascularized omental tissue transfer(VOLT)for lymphedema treatment,a subject of considerable clinical importance.I believe it is appropriate to particularly commend the authors for their detailed analysis of techniques and various surgical options.The discussion on the immunological properties of the omentum and its value as a donor site for lymph nodes was notably insightful.Significant points from this review include the efficacy of VOLT in reducing the volume of limbs with lymphedema and related symptoms,and the insight into the use of robotic surgery,which opens new perspectives on harvesting techniques.I would like to congratulate the authors for their meticulous research because a better level of evidence is needed in the field of lymphedema surgery.This article not only enriches our understanding of lymphedema and its treatment options but also offers a valuable guide for physicians dealing with this debilitating complication.At our center,we perform vascularized omental lymph node transfer for the treatment of limb lymphedema,mainly after gynecological cancer[2,3].
