LAUSR

BACKGROUND A physiological and minimal invasive form of surgery with minimal risk to treat lymphedemas is the so-called supermicrosurgical lymphovenous anastomosis (LVA) where a lymph vessel is connected with a venole. METHODS Augmented reality intraoperative indocyanin green (ICG) lymphography-navigated modified "simplified lymphovenous anastomosis" were performed on 32 patients (between 2018 and 2019) with secondary upper extremity lymphedema refractory to conservative therapy (manual lymph drainage and compression therapy). For the assessment of lymphatic supermicrosurgery, an operating microscope in which a near-infrared illumination system is integrated (Leica M530 OHX with glow technology ULT530, Leica Microsystems) was used. RESULTS 63 LVAs were performed with modified "simplified lymphovenous anastomosis" lymphography-guidance on 27 upper extremities and 5 lower extremities. Patency after lymphovenous anastomosis was confirmed by augmented ICG intraoperative microscopy - all patients showed good patency. CONCLUSIONS Supermicrosurgery in the case of LVA is minimally invasive, highly effective and shows very low complication rate. The practice of LVA is restricted by the surgeon/equipment-related factors, and its effectiveness limited by technical constraints.