Another first for lymphoedema care in New Zealand! Today we performed a Lymph Node Venous Anastomosis (LNVA). LNVA is similar to LymphoVenous Anastomosis (LVA), in that we connect veins to the lymphatic system using specialized microsurgery (“supermicrosurgery”). In this way, we construct bypasses around system blockages. But where LVA fixes only a single lymphatic, LNVA can drain multiple lymphatics with just one connection. This technique relies on patients to still have lymph nodes present. An example would be a patient who has lymph nodes removed in the pelvis for cancer, but still has their groin lymph nodes. We identify a target lymph node identified on pre-operative scanning. This is surgically exposed, while preserving all the lymphatics that feed into it. A hole is made in the outer shell (cortex) of the lymph node, and we drill inside. The lymph node now leaks its fluid through our new opening, to which we sew a nearby vein. The vein now acts like a leech, draining away fluid from the lymph node and all the lymphatics that feed it. Big thanks to the team at Auckland Plastic Surgery Group and Ormiston Hospital for making today happen, and to our special patient for permission to photograph and share her surgery.
