WORKSHOP IN LYMPHATIC MICROSURGERY - 2nd CADAVER
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2nd CADAVER WORKSHOP IN LYMPHATIC MICROSURGERY Anatomy, diagnosis, pre-operative mapping and surgical techniques in human cadaver model 25th - 26th June 2020 Chairs: Jaume Masià, Sinikka Suominen Faculty: • Joseph Dayan (USA) • Jaume Masià (Spain) • Hiroo Suami (Australia) • Sinikka Suominen (Finland)
I CADAVER WORKSHOP
IN LYMPHATIC
MICROSURGERY
PROGRAM OVERVIEW
The course is available for residents and specialists in of whole vascularised lymph nodes (LNT) had been
plastic surgery (worldwide) to learn or further refine their shown to significantly reduce the volume of affected
skills in lymphatic microsurgery. limbs. Moreover, actual scientific evidence sustains
the concept of “preventive lymphatic microsurgery” to
Development of a training course in lymphatic prevent secondary lymphedema in patients undergoing
reconstructive microsurgery as integrative part of the major tumor surgery (e.g. breast, melanoma) involving
Reconstructive Microsurgery European School (RMES). excision of major lymphatic stations. Microsurgical
reconstruction of the lymphatic circulation is performed
during the same operation with the tumor excision. As
Lymphedema is a chronic debilitating disease affecting such, the development of secondary lymphedema can
actually about 140 million people world-wide (1). Induced be avoided.
either by surgical removal of lymph nodes (e.g. secondary
to cancer invasion) or presenting as inherited disease (e.g. However, in-depth knowledge of the aetiology, anatomy
primary lymphedema) in both upper and lower extremity, of the diseased area as well as extensive microsurgical
this disease is characterised by progressive lymph stasis experience are instrumental prerequisites for successful
which in turn leads to adipose hypertrophy and fibrosis of therapy.
the subcutaneous tissues. In the advanced stages, can induce
life-threatening conditions, exposing the patients to serious One of the most challenging caveats to achieve success
complications which untreated can even lead to limb loss. is learning to perform the microsurgical lymphatic
procedures from intraoperative identification of lymph
During the last 40 years, much progress has been made in vessels to performing lymphovenous anastomoses or
understanding the mechanisms of disease and the ways harvesting a vascularised lymph-nodes to be used later
to treat it, nevertheless no efficient standardised therapy on the same patient as free tissue transfer.
exists to date. Looking at the actual evidence in terms of
ways to treat lymphedema, both microsurgical lymphatic Such skills can only be learned and mastered in the
bypass of the obstructed areas as well as redirectioning laboratory on experimental animal models and then
of the lymph flow into the venous system through further refined on human tissue (e.g. cadavers).
lymphovenous anastomosis (LVA) or transplantation
COURSE STRUCTURE AND PROGRAM
Two-days intensive course focused on lymphatic microsurgery including over 15 hours of practical training fresh cadaveric
material, with only 2 dissecting participants per operating table
DAY 1 - 25th June 2020 DAY 2 - 26th June 2020
• How to solve problems in lymph-node
transfer
• Anatomy of the lymphedema system • How to do the follow up in lymph-node
• Physiopathology of the Lymphatic system transfer
08.30 - 10.30 • Lymphedema classification 08.30 - 10.30 • Lipedema vs Lymphedema: diagnosis and
• How to assess the lymphedema patient therapeutic approach
• Mapping the lymphatic system • How to perform a lipo-aspiration in
lymphedema and lipoedema patients
• Patient selection for lymphedema surgery
10.30 - 10.45 Coffee Break 10.30 - 10.45 Coffee Break
Practical Session 1 Practical Session 2
How to rise the vascularised lymph nodes The recipient vessels for lymph-node transfer
10.45 - 14.30 10.45 - 14.30
• Submental lymph-node transfer • Axillary region,
• Supraclavicular lymph-node transfer • Cubital fossa region
14.30 - 15.00 Lunch Break 14.30 - 15.00 Lunch Break
Performing such surgery requires not only precise
microsurgical and supramicrosurgical skills but
AIMS OF THE PROJECT • Superficial inferior epigastric lymph
• Distal upper limb region
• Medial tight region
node transfer
To develop a practical training course in lymphatic • Popliteal region
also structured knowledge about the preoperative 15.00 - 19.30 • Lateral thoracic lymph-node transfer 15.00 - 19.30
• Distal lower limb region
examination of lymphatic vessels (e.g. clinical reconstructive microsurgery in cadaver models. • Mesenteric lymph-node transfer
Lipo-aspiration in lymphedema patients and
• Gastroepiploic lymp- node transfer
examination, PDE Examination, Lympho-MRI). Furthermore the participants should be trained in anatomy, lipoedema patients
physiology of the lymphatic System focused on lymph-
These procedures need proper training before being node transfer and lymph-venous anastomoses, indications
applied clinically. and treatment options as well as postoperative care.
The Reconstructive Microsurgery European School
(RMES) is an established, world-wide known program LOCATION COURSE DESCRIPTION
which offers the unique opportunity to surgeons Human Anatomy Department. School of Medicine The course consists mainly of practical exercises which
willing to learn the entire spectrum of reconstructive Universidad Miguel Hernández (San Juan Campus). will be performed under either loupe magnification. The
microsurgery. From basic courses (e.g. microsurgical Alicantre (SPAIN) first practical session starts with a detailed introduction
techniques, flap harvesting) to clinical immersion of the Lymphatic System, Physiopathology of the
fellowships, this program provides a one of a kind lymphatic system, the way to assess the lymphedema
platform able to train microsurgeons in all aspects of patient and the patient selection of lymphedema
reconstructive surgery, from learning basic skills to surgery followed by the way to rise the different types of
performing free tissue transfers. vascularised lymph nodes.
Since lymphatic microsurgery is a field experiencing The second day is dedicated to solve problems and the
a continuously growing interest within the plastic follow up in lymph node transfer, the way to perform
surgeons community, introducing a practical course
focused on specific technical lymphatic microsurgery
COURSE VENUE a lipoaspiration in lymphedema and lipoedema patients
and the surgical concepts of the Lymphatic disorders
skills as well as pre- and intraoperative examination of Edificio Severo Ochoa, nº4 followed by practical exercices in the recipent vessels
lymphatics is justified and will be a welcomed addition Sector Sup 10, 33-47 for lymph-node transfer.
to this program. Campus San Juan, Crtra Alicante Km 322
03550 Alicante
REGISTRATION FEE: 1.650 € SELECTED REFERENCES/ 6. Cheng, Ming-Huei; Lin, Chia-Yu; Patel, Ketan. The
Groin vs. Submental Vascularized Lymph Node Flaps:
SUGGESTED READING A Head-to-Head Comparison of Surgical Outcomes
Following Treatment for Upper Limb Lymphedema.
CONTACT DETAILS 1. Brorson H, Ohlin K, Olsson G, Svensson B, Svensson H Plastic & Reconstructive Surgery. 136(4S):135,
(June 2008). “Controlled compression and liposuction October 2015.
Reconstructive Microsurgery European School (RMES)
treatment for lower extremity lymphedema”. 7. Long-Term Patency of Lymphovenous Anastomoses:
• Elena Mohedano: elena.mohedano@rmes.es
Lymphology. 41 (2): 52–63. A Systematic Review.Tourani, Saam S.; Taylor, G. Ian;
• Anna Roca: info@rmes.es
2. Neyazaki T, Kupic EA, Marshall WH, Abrams HL. Ashton, Mark W. Plastic & Reconstructive Surgery.
(+34) 93 556 55 05
Collateral lymphatico-venous communications 138(2):492-498, August 2016.
after experimental obstruction of the thoracic duct. 8. Breast Cancer–Related Lymphedema: Quality of Life
Radiology 1965;85:423–432. after Lymph Node Transfer. De Brucker, Ben; Zeltzer,
3. Olszewski WL. Lymphovenous microsurgical shunts Assaf; Seidenstuecker, Katrin. Plastic & Reconstructive
in treatment of lymphedema of lower limbs: A 45-year Surgery. 137(6):1673- 1680, June 2016.
experience of one surgeon/one center. Eur J Vasc 9. Overview of Lymph Node Transfer for Lymphedema
Endovasc Surg. 2013;45:282–290. Treatment. Ito, Ran; Suami, Hiroo. Plastic & Reconstructive
4. Maegawa J, Yabuki Y, Tomoeda H, Hosono M, Surgery. 134(3):548-556, September 2014.
Yasumura K. Outcomes of lymphaticovenous side-to- 10. Furukawa, Hiroshi; Osawa, Masayuki; Saito, Akira;
end anastomosis in peripheral lymphedema. J Vasc et al. Microsurgical Lymphaticovenous Implantation
Surg. 2012;55:753–760. Gloviczki P, Hollier LH, Nora Targeting Dermal Lymphatic Backflow Using
FE, Kaye MP. The natural history of microsurgical Indocyanine Green Fluorescence Lymphography in the
lymphovenous anastomoses: An experimental study. Treatment of Postmastectomy Lymphedema. Plastic &
J Vasc Surg. 1986;4:148–156. Reconstructive Surgery. 127(5):1804-1811, May 2011.
5. Al Assal F, Cordeiro AK, De Souza e Castro I. A new 11. Campisi, Corrado C.; Larcher, Lorenz; Lavagno, Rosalia
technique of microlympho-venous anastomoses: et al. Microsurgical Primary Prevention of Lymphatic
Experimental study. J Cardiovasc Surg (Torino) Injuries following Breast Cancer Treatment. Plastic &
1988;29:552–555. Reconstructive Surgery. 130(5):749e-750e, November
2012.
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