In a Macquarie University Hospital first, surgeons performed fluorescence imaging assisted Lymphovenous Anastomosis for lymphoedema patients experiencing mild to moderate lymphoedema.

For patients with early-stage lymphoedema, the use of compression garments, exercise, skin care and lymphatic drainage massage have offered an effective solution in reducing and controlling symptoms. More recently, for those with more severe lymphoedema, liposuction and lymph node transfer surgery have become viable surgical options.

However, patients with lymphoedema who fall in the middle of the spectrum, have had no satisfactory treatment option. Many struggle with the compression garments and are not candidates for surgical intervention. With time, these patients can progress to advanced fatty-type lymphoedema.

Earlier this year, Lymphovenous Anastomosis (LVA) was performed in a Macquarie University Hospital first. Suitable for mild to moderate lymphoedema sufferers and well established overseas, the procedure was introduced into Australia through an international collaboration that saw MA Health bring two top plastic surgeons from Okayama University in Japan to mentor plastic surgeon Dr Quan Ngo, along with other members of the multidisciplinary team. These included clinical lead Dr Helen Mackie and lymphoedema therapist and program manager Louise Koelmeyer.

LVA involves the surgical creation of a local connection between the lymphatic vessels and veins to facilitate drainage of accumulated lymph fluid into the systemic circulation, thereby reducing fluid collection in the affected limbs and limiting further lymphoedema progression.

“This is called super-microsurgery,” said Professor John Boyages, Director of the Australian Lymphoedema Education Research and Treatment (ALERT) centre and Professor of Breast Oncology at the Faculty of Medicine and Health Sciences at Macquarie University. “Vascular surgeons are used to joining veins and arteries, but here they are joining hair-sized lymphatics – around one-third of a millimetre – to very small veins called venules.

“The goal of the procedure is to allow the lymphatic system to drain. The pressures have to be right to join the two.”

To enable the necessary detailed visualisation of the lymphatic system prior to the surgery, Macquarie University Hospital has acquired an Indocyanine Green (ICG) Fluorescence lymphography and infrared vein viewer.

MQ Health is also delighted to have Associate Professor Hiroo Suami on board. Dr Suami trained in Japan as a reconstructive microsurgeon and is now a world-renowned expert in visualising the human lymphatic system. Recruited from the University of Texas MD Anderson Cancer Centre in Houston, Dr Suami helped draft the protocols for the procedure at Macquarie University Hospital and is involved in patient selection.

“After investigating the anatomy of the lymphatic system at the University of Melbourne using my original method, I was proud to join the prestigious top cancer centre hospital in the US eight years ago, when they had just started the lymphoedema surgical centre,” said Dr Suami.

“This has given me a unique combination of scientific and clinical knowledge, which I am now delighted to be applying at MQ Health, establishing effective training models for surgeons, writing protocols, assisting with the purchase of a superior ICG lymphography device, and helping to assess patients through my anatomical expertise.”

“Nothing was available previously to this group of patients,” explained Professor Boyages. “We are very excited to be offering LVA at Macquarie University Hospital as part of our growing services in lymphoedema and we are hoping to raise funds through grants or fundraising to support this unique work.”

Linking Clinical Practice and Research in LVA

“Oddly enough, LVA was invented in Australia in the 1970s but never taken up,” said Professor Boyages, who has ensured that an LVA research program has been established in conjunction with the clinical program. “Now that we’ve taken it up as part of our lymphoedema services offered to patients, we have put in place a strong program to measure success and ensure we achieve the best outcomes for patients.”

This will add to other strong research programs that the Macquarie-based ALERT program conducts – including the particularly strong data it has on liposuction for patients with advanced lymphoedema.

“Our colleague at Vanderbilt University, Professor Sheila Ridner, one of the world’s leading researchers in lymphoedema treatment and management, said to me earlier this year that, to her knowledge, MQ Health is the only place in the world that can test LVA in a research environment,” said Professor Boyages. “We look forward to sharing our first research results with the wider community as early as 2018.”