Lymphatic surgery

Procedure

The lymph is absorbed into the lymphatic system by the finest capillaries in the body and transported into the venous system via the central lymphatic system and the thoracic duct. The thoracic duct, also known as the thoracic duct, is the largest lymphatic duct in the human body. The thoracic duct begins in the abdominal cavity as the cisterna chyli and then runs through the diaphragm along the spine until it opens into the left venous angle, where it merges with the venous blood. It plays an important role in the immune system by transporting lymph, which is rich in immune cells, back into the blood and thus helps to fight infections. It also supports the detoxification and fluid balance of the body and transports proteins and fats from the digestive system into the blood.

Lymphedema

The primary therapy for lymph fluid congestion in the tissue is always complex decongestion therapy using lymph drainage, compressive wrapping and compression stockings. If there is no improvement, surgical therapy can be evaluated.

Lymphatic surgery includes microsurgical reconstructive procedures (lympho-venous anastomoses, vascularized lymphatic tissue transfer, etc.) and tissue-reducing procedures (liposuction, tissue reduction). Furthermore, a distinction is made between the treatment of peripheral lymphatic diseases (e.g. lymphoedema of the extremities or head, etc.) and central lymphatic diseases (congenital and acquired central lymphatic drainage disorders, chylothorax, chylopericardium, chylascites, protein-losing enteropathy, etc.).

Lymphatic surgery techniques

Lymphovenous anastomoses (LVA)

The finest lymph vessels (0.3 -1 mm) are connected directly to small veins in the arms, legs or neck under the microscope in order to improve the drainage of lymphatic fluid in the periphery. The connections function in the sense of “short-circuit connections” by draining the lymph fluid peripherally directly into the blood system.

Vascularized lymph tissue transplantation (VLTT)

This procedure involves the removal of healthy lymphatic tissue incl. Lymph vessels and possibly lymph nodes are removed from another part of the body and transplanted to the corresponding extremity including vessels to improve lymph drainage in the affected area. Lymph tissue can be removed from various locations (armpit, groin, neck, abdomen). In recent years, laparoscopic removal from the abdominal cavity, e.g. from the greater omentum, has become established. Due to the anatomy, the risk of additional lymphedema of the extremities is virtually eliminated when the omentum is removed. The transplanted lymphatic tissue can initially act as a “sponge” that removes the lymphatic fluid into the venous system. In addition, new lymphatic vessels grow over a period of approx. 2 years, which can improve drainage in the long term.

Liposuction

This technique can be used to gently remove fat and connective tissue deposits (fibrosis) that have accumulated as a result of long-term lymphoedema. In very rare, severe cases, tissue must also be resected by open surgery.

Together with the Department for Angiology and Physiotherapy, patients with difficult-to-treat lymphoedema or problems associated with lymphoedema are discussed in the interdisciplinary lymphoedema consultation.

Central lymphatic drainage disorders

Central lymphatic surgery deals with the treatment of disorders of the central lymphatic drainage deep inside the body. This can lead to persistent leakage of lymph fluid into various body cavities (lung cavity (pleura), abdominal cavity (peritoneum), pericardium, etc.) or to drainage disorders and the development of protein loss (protein-losing enteropathy, bronchitis plastica, etc.) or peripheral lymphoedema, particularly in the lower half of the body.

Robotic-assisted lymphatic surgery

Microsurgery and supermicrosurgery have been enabling high-precision microsurgical procedures on the peripheral lymphatic system for a decade. In robotic-assisted microsurgery and supermicrosurgery, robotic arms controlled by surgeons have been used at the USZ for some years now to connect even finer vessels and also to operate more effectively in depth on the central lymphatic system.