Published online Apr 18, 2021. doi: 10.5500/wjt.v11.i4.129
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
Secondary lymphedema after surgery is a progressive, chronic disease that is still not completely curable. Over time a multitude of surgical therapy options have been described with its individual complications and side effects.
Due to technical progress in robot-assisted surgery, many advances have been made in this field within the last few years. This has significantly increased the precision and tissue-sparing work during abdominal interventions and made omental flap harvest much easier. Our motivation was to compare the complications of robot-assisted lymph node transfer in the treatment of secondary limb lymphedema.
Since 2010 we use the autologous supraclavicular lymph node transplantation (VLNT) and the lymph vessel transplantation (LVTx) according to Baumeister. Since 2017 we perform robot assisted free VLNT from the omentum. Our motivation was to summarize and point out the single-center complications in LVTx and free VLNT.
In this study, data from three different collectives were collected and evaluated. A total of 87 patients undergoing treatment at our clinic were included. In total n = 18 robot-assisted omental lymph node transplantations, n = 33 supraclavicular lymph node transplantations and n = 36 Lymph vessel transplantations were analyzed. The data collection was performed preoperatively during consultations, as well as three weeks, six months and twelve months after surgical treatment. Descriptive statistics were used to analyze the patient data.
In the omental VLNT, three patients showed a slight abdominal sensation of tension within the first 12 postoperative days. No other donor side morbidities occurred. 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.
Concerning donor side morbidity, robot-assisted omental VLNT is clearly superior to supraclavicular lymph node transplantation and LVTx.
At present, only a few publications on robot-assisted VLNT have been published. Because of the short time, no reliable assessment concerning long-term complications can be yet made. The evaluation will have to be clarified in future studies.