Observational Study
Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Transplant. Apr 18, 2021; 11(4): 129-137
Published online Apr 18, 2021. doi: 10.5500/wjt.v11.i4.129
Donor defects after lymph vessel transplantation and free vascularized lymph node transfer: A comparison and evaluation of complications
Gunther Felmerer, Dominik Behringer, Nadine Emmerich, Marian Grade, Adam Stepniewski
Gunther Felmerer, Dominik Behringer, Adam Stepniewski, Division of Plastic Surgery, Department for Trauma Surgery, Orthopedics and Plastic Surgery, University Medical Center Goettingen, Goettingen 37075, Lower Saxony, Germany
Nadine Emmerich, Georg-August University Goettingen, University Medical Center Goettingen, Goettingen 37075, Lower Saxony, Germany
Marian Grade, Department of General, Visceral and Pediatric Surgery, University Medical Center Goettingen, Goettingen 37075, Lower Saxony, Germany
Author contributions: Felmerer G and Behringer D contributed equally to this work; Felmerer G and Behringer D designed the research study; Felmerer G, Stepniewski A, Grade M and Behringer D performed the surgeries; Grade M contributed in general surgery issues; Behringer D and Stepniewski A analyzed the data and wrote the manuscript; Emmerich N and Behringer D provided figures and tables; all authors have read and approved the final manuscript.
Institutional review board statement: The study was reviewed and approved by the ethics committee of University Medical Center Goettingen, Germany (Approval No. 10/10/14).
Informed consent statement: All study participants, or their legal guardian, provided informed written consent prior to study enrollment.
Conflict-of-interest statement: There are no conflicts of intrest to report.
Data sharing statement: Technical appendix, statistical code, and dataset available from the corresponding author at [adam.stepniewski@med.uni-goettingen.de]. Participants gave informed consent for data sharing and the presented data are anonymized and risk of identification is low.
STROBE statement: The authors have read the STROBE Statement – checklist of items, and the manuscript was prepared and revised according to the STROBE Statement – checklist of items.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Adam Stepniewski, MD, Doctor, Surgeon, Division of Plastic Surgery, Department for Trauma Surgery, Orthopedics and Plastic Surgery, University Medical Center Goettingen, Robert-Koch-Strasse 40, Goettingen 37075, Lower Saxony, Germany. adam.stepniewski@med.uni-goettingen.de
Received: August 17, 2020
Peer-review started: August 17, 2020
First decision: December 21, 2020
Revised: January 2, 2021
Accepted: March 12, 2021
Article in press: March 12, 2021
Published online: April 18, 2021
Processing time: 233 Days and 14.4 Hours
Abstract
BACKGROUND

Secondary lymphedema after surgical interventions is a progressive, chronic disease that is still not completely curable. Over the past years, a multitude of surgical therapy options have been described.

AIM

To summarize the single-center complications in lymph vessel (LVTx) and free vascularized lymph node transfer (VLNT).

METHODS

In total, the patient collective consisted of 87 patients who were undergoing treatment for secondary leg lymphedema during the study period from March 2010 to April 2020. The data collection was performed preoperatively during consultations, as well as three weeks, six months and twelve months after surgical treatment. In the event of complications, more detailed follow-up checks were carried out. In total n = 18 robot-assisted omental lymph node transplantations, n = 33 supraclavicular lymph node transplantations and n = 36 Lymph vessel transplantations were analyzed. An exemplary drawing is shown in Figure 1. A graphical representation of patient selection is shown in Figure 2. Robotic harvest was performed with the Da Vinci Xi Robot Systems (Intuitive Surgical, CA, United States).

RESULTS

In total, 11 male and 76 female patients were operated on. The mean age of the patients at study entry was: omental VLNT: 57.45 ± 8.02 years; supraclavicular VLNT: 49.76 ± 4.16 years and LVTx: 49.75 ± 4.95 years. The average observation time postoperative was: omental VLNT: 18 ± 3.48 mo; supraclavicular VLNT: 14.15 ± 4.9 and LVTx: 14.84 ± 4.46 mo. In our omental VLNT, three patients showed a slight abdominal sensation of tension within the first 12 postoperative days. No other donor side morbidities occurred. No intraoperative conversion to open technique was needed. Our supraclavicular VLNT collective showed 10 lift defect morbidities with one necessary surgical intervention. In our LVTx collective, 12 cases of donor side morbidity were registered. In one case, surgical intervention was necessary.

CONCLUSION

Concerning donor side morbidity, robot-assisted omental VLNT is clearly superior to supraclavicular lymph node transplantation and LVTx.

Keywords: Lymph surgery; Vascularized lymph node transfer; Lymph vessel transfer; Robot-assisted surgery; Da Vinci Xi; Donor side morbidity

Core Tip: Secondary lymphedema after surgical interventions is a progressive, chronic disease that is still not completely curable. Since the establishment of laparoscopic minimally invasive surgery in everyday clinical practice and, most recently, further development using robot-assisted procedures, there have been significant changes in reconstructive lymph surgery. In our study we wanted to summarize our single-center complications in lymph vessel and free vascularized lymph node transfer. The patient collective consisted of 87 patients. In summary, robot-assisted omental vascularized lymph node transfer is clearly superior to supraclavicular vascularized lymph node transfer and lymph vessel due to the reliably low donor side morbidity.