Surgeons have used a robot to reconstruct the central lymphatic system, marking a major medical milestone.
The University Hospital Zurich's (USZ) Department of Plastic Surgery and Hand Surgery team pioneered the revolutionary approach when they faced an insurmountable challenge in removing a complex bulge within a patient’s central lymphatic system.
The patient, a 47-year-old woman, had endured prolonged agony and multiple treatments.
Her persistent left abdominal pain, exacerbated by physical activity and accompanied by severe circulatory issues, hindered her mobility.
Dynamic MR lymphangiography revealed a cystic dilation in her left pelvic lymphatic vessels, akin to the size of a pear, that was causing recurrent accumulation of lymph fluid.
The condition threatened her autonomic nervous system and spinal functions, risking circulatory complications.
Ailments concerning the central lymphatic system are typically observed in infants and children due to congenital malformations.
These conditions manifest in chronic effusions around vital organs, resulting in debilitating problems like extensive lymphoedema and protein loss.
Conventional treatments often revolve around medication and specialised diets to mitigate lymph flow.
Surgical intervention remains a rarity due to the inherent complexities of reaching deeply situated sites within the body and the minute size of lymph vessels.
Prior attempts to treat the patient’s condition through sclerotherapy had failed, prompting a multidisciplinary team to explore innovative solutions.
Nicole Lindenblatt, Deputy Director of the Department for Plastic Surgery and Hand Surgery, specialising in microsurgery, proposed the novel approach – a reconstructive microsurgical procedure.
This technique involved establishing a new connection between the enlargement and the left ovarian vein, facilitating the drainage of lymphatic fluid back into the central venous system.
Opting for the surgery, the patient underwent meticulous planning with a proficient team comprising visceral surgery and interventional radiology specialists at USZ. The remarkable procedure, detailed in the journal Plastic and Reconstructive Surgery – Global Open, utilised the Symani robotic surgical system.
It marked the world’s premiere application of a microsurgical system in central lymphatic system surgery. Post-operation, the patient exhibited remarkable recovery – within three months, symptoms were nearly non-existent.
Her restored mobility allowed her to walk for extended periods without weakness or circulatory issues.
Lindenblatt, an early adopter of the Symani system since 2021, lauds its precision in operating on intricate vessels within deep tissues.
The authors concluded: ‘To our knowledge, this is the first anastomosis on the central lymphatic system performed with the robotic system. Of note, the robotic technology allowed reconstruction of the retroperitoneal central lymphatics via limited laparotomy.
‘Considering the high morbidity and rarity of pathologies of the central lymphatic system, surgery should be performed only after careful planning with utmost precision. In this context, the Symani Surgical System not only improved precision but also allowed significantly smaller surgical access and thus a smaller final scar. Based on this, robotic-assisted microsurgery shows great potential to expand the reconstructive treatment options for central lymphatic anomalies.’
Photo caption: Nicole Lindenblatt operates on the central lymphatic system with the microsurgery robot Symani
