Doctors from the Department of Plastic Surgery and Hand Surgery at the Universitätsspital Zürich created a new drain to relieve the patient’s agonizing lymph congestion. For the first time, a microsurgical operating system was used for such a procedure.
By the time the patient came to the Department of Plastic Surgery and Hand Surgery of the USZ, she already had a long history of suffering and treatment behind her. The 47-year-old woman had been suffering from excruciating pain in her left abdomen for a long time, which intensified after physical activity. Her pain was accompanied by severe circulatory problems, making it difficult for her to walk 100 meters at a time.
As the symptoms were increasing, a dynamic MR lymphangiography was performed, which allows the lymph channels and lymph nodes to be visualized. The lymphangiography showed a cystic dilatation of the left pelvic lymphatic vessels about the size of a pear, in which lymph fluid was repeatedly accumulating. This led to the massive pain and probably caused the circulatory problems by influencing the autonomic nervous system as well as the spine.
After detailed investigations by specialists in several fields, a further attempt at sclerotherapy was rejected because of the risk of blocking the lymphatic vessels leading to the enlargement. “This would have meant that the patient could have developed lymph congestion in the lower half of her body,” says Nicole Lindenblatt, Deputy Director of the Department for Plastic Surgery and Hand Surgery and specialist in microsurgery and supermicrosurgery.
Instead, Nicole Lindenblatt’s treatment team suggested a reconstructive microsurgical procedure to the patient, in which a new connection is made between the enlargement and the left ovarian vein, allowing the lymphatic fluid to drain back into the central venous system. The patient decided to have the operation. The procedure was planned together with an established treatment team consisting of specialists from visceral surgery and interventional radiology at the USZ.
The operation was performed using the Symani robotic surgical system. This is the first time in the world that the microsurgical system has been used in an operation on a person’s central lymphatic system. And the microsurgical procedure was successful. The patient’s pain disappeared almost immediately after the operation.
Three months after the operation, she hardly felt any symptoms and had recovered so well that she was able to walk for several hours without any weakness or circulatory reactions and was no longer restricted in her everyday life.
👉 USZ – Universitätsspital Zürich – University Hospital Zurich
