Archives of Plastic Surgery

Korean Society of Plastic and Reconstructive Surgeons (대한성형외과학회)
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Photoacoustic lymphangiography before and after lymphaticovenular anastomosis

  • Oh, Anna (Department of Plastic and Reconstructive Surgery, Keio University School of Medicine) ;
  • Kajita, Hiroki (Department of Plastic and Reconstructive Surgery, Keio University School of Medicine) ;
  • Matoba, Eri (Department of Plastic and Reconstructive Surgery, Keio University School of Medicine) ;
  • Okabe, Keisuke (Department of Plastic and Reconstructive Surgery, Keio University School of Medicine) ;
  • Sakuma, Hisashi (Department of Plastic and Reconstructive Surgery, Yokohama Municipal Citizen's Hospital) ;
  • Imanishi, Nobuaki (Department of Anatomy, Keio University School of Medicine) ;
  • Takatsume, Yoshifumi (Department of Anatomy, Keio University School of Medicine) ;
  • Kono, Hikaru (Department of Plastic and Reconstructive Surgery, Keio University School of Medicine) ;
  • Asao, Yasufumi (Luxonus Inc.) ;
  • Yagi, Takayuki (Luxonus Inc.) ;
  • Aiso, Sadakazu (Department of Anatomy, Keio University School of Medicine) ;
  • Kishi, Kazuo (Department of Plastic and Reconstructive Surgery, Keio University School of Medicine)
  • Received : 2020.12.09
  • Accepted : 2021.02.04
  • Published : 2021.05.15
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Abstract

Background Lymphaticovenular anastomosis (LVA) is a minimally invasive surgical procedure used to treat lymphedema. Volumetric measurements and quality-of-life assessments are often performed to assess the effectiveness of LVA, but there is no method that provides information regarding postoperative morphological changes in lymphatic vessels and veins after LVA. Photoacoustic lymphangiography (PAL) is an optical imaging technique that visualizes the distribution of light-absorbing molecules, such as hemoglobin or indocyanine green (ICG), and provides three-dimensional images of superficial lymphatic vessels and the venous system simultaneously. In this study, we performed PAL in lymphedema patients before and after LVA and compared the images to evaluate the effect of LVA. Methods PAL was performed using the PAI-05 system in three patients (one man, two women) with lymphedema, including one primary case and two secondary cases, before LVA. ICG fluorescence lymphography was performed in all cases before PAL. Follow-up PAL was performed between 5 days and 5 months after LVA. Results PAL enabled the simultaneous visualization of clear lymphatic vessels that could not be accurately seen with ICG fluorescence lymphography and veins. We were also able to observe and analyze morphological changes such as the width and the number of lymphatic vessels and veins during the follow-up PAL after LVA. Conclusions By comparing preoperative and postoperative PAL images, it was possible to analyze the morphological changes in lymphatic vessels and veins that occurred after LVA. Our study suggests that PAL would be useful when assessing the effect of LVA surgery.

Keywords

Acknowledgement

This research was funded by the ImPACT Program of Council for Science, Technology and Innovation (Cabinet Office, Government of Japan) (No.185-4/2016-PM10-03-01).

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