Lymphedema is a debilitating disorder caused by impaired drainage of the lymphatic system.In the Western world,lymphedema most often arises secondary to the treatment of malignancy.Patients with lymphedema experience ...Lymphedema is a debilitating disorder caused by impaired drainage of the lymphatic system.In the Western world,lymphedema most often arises secondary to the treatment of malignancy.Patients with lymphedema experience progressive swelling,pain,numbness,and tingling,and decreased quality of life.Those with persistent symptoms may be subject to chronic cellulitis.The advent of microsurgery has enabled clinicians to transplant donor lymph nodes and their blood supply from a healthy site to the affected area in a procedure known as vascularized lymph node transplant(VLNT).One donor region is the omentum.Vascularized omental lymph node transfer(VOLT)has been shown to decrease limb volume,circumference,and subjective symptoms of lymphedema.The immunologic properties of the omentum make it a particularly useful lymph node donor site for patients with lymphedemarelated cellulitis.The omentum may be harvested laparoscopically,with robotic assistance,or through a small laparotomy incision.In this review,we describe the relevant anatomy and history of VOLT as well as operative techniques.The risks,benefits,and relevant outcome studies will be reviewed.Recent applications of robotic surgery to VOLT will be addressed.展开更多
Aim:The aim of this systematic review was to summarize clinical and patient-reported outcomes(PROs)for various vascularized lymph node transfer(VLNT)donor sites and identify gaps in the literature to guide future rese...Aim:The aim of this systematic review was to summarize clinical and patient-reported outcomes(PROs)for various vascularized lymph node transfer(VLNT)donor sites and identify gaps in the literature to guide future research.Methods:A literature search of five databases was performed for articles related to VLNT that were published prior to November 2021.Studies that included clinical outcomes or PROs from at least five adult patients who received VLNTs to treat lymphedema were included.Results:Sixty-six studies met the study criteria.Most studies reported improved limb circumference/volume,reduction or discontinuation of conservative therapy,infection rate reduction,improved PROs,or postoperative imaging findings reflecting functional lymph nodes.There were significantly lower infection rates(P<0.05)and a trend towards improved PROs in patients who received intra-abdominal flaps,but overall few studies reported these outcomes.There were no significant differences in complication rates at the donor or recipient site based on VLNT donor sites,or between intra-abdominal vs.extra-abdominal VLNT donor sites,although these outcomes are not uniformly reported.Conclusion:This meta-analysis identified that intra-abdominal donor sites have the potential to reduce postoperative infectious episodes more than extra-abdominal donor sites.Though recent investigations address many understudied VLNT donor sites,larger comparative studies and a standardized methodology are needed to better characterize postoperative outcomes,which can offer more concrete evidence to guide surgical practice.展开更多
文摘Lymphedema is a debilitating disorder caused by impaired drainage of the lymphatic system.In the Western world,lymphedema most often arises secondary to the treatment of malignancy.Patients with lymphedema experience progressive swelling,pain,numbness,and tingling,and decreased quality of life.Those with persistent symptoms may be subject to chronic cellulitis.The advent of microsurgery has enabled clinicians to transplant donor lymph nodes and their blood supply from a healthy site to the affected area in a procedure known as vascularized lymph node transplant(VLNT).One donor region is the omentum.Vascularized omental lymph node transfer(VOLT)has been shown to decrease limb volume,circumference,and subjective symptoms of lymphedema.The immunologic properties of the omentum make it a particularly useful lymph node donor site for patients with lymphedemarelated cellulitis.The omentum may be harvested laparoscopically,with robotic assistance,or through a small laparotomy incision.In this review,we describe the relevant anatomy and history of VOLT as well as operative techniques.The risks,benefits,and relevant outcome studies will be reviewed.Recent applications of robotic surgery to VOLT will be addressed.
文摘Aim:The aim of this systematic review was to summarize clinical and patient-reported outcomes(PROs)for various vascularized lymph node transfer(VLNT)donor sites and identify gaps in the literature to guide future research.Methods:A literature search of five databases was performed for articles related to VLNT that were published prior to November 2021.Studies that included clinical outcomes or PROs from at least five adult patients who received VLNTs to treat lymphedema were included.Results:Sixty-six studies met the study criteria.Most studies reported improved limb circumference/volume,reduction or discontinuation of conservative therapy,infection rate reduction,improved PROs,or postoperative imaging findings reflecting functional lymph nodes.There were significantly lower infection rates(P<0.05)and a trend towards improved PROs in patients who received intra-abdominal flaps,but overall few studies reported these outcomes.There were no significant differences in complication rates at the donor or recipient site based on VLNT donor sites,or between intra-abdominal vs.extra-abdominal VLNT donor sites,although these outcomes are not uniformly reported.Conclusion:This meta-analysis identified that intra-abdominal donor sites have the potential to reduce postoperative infectious episodes more than extra-abdominal donor sites.Though recent investigations address many understudied VLNT donor sites,larger comparative studies and a standardized methodology are needed to better characterize postoperative outcomes,which can offer more concrete evidence to guide surgical practice.
