Observational Study
Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Transplant. Apr 18, 2021; 11(4): 129-137
Published online Apr 18, 2021. doi: 10.5500/wjt.v11.i4.129
Donor defects after lymph vessel transplantation and free vascularized lymph node transfer: A comparison and evaluation of complications
Gunther Felmerer, Dominik Behringer, Nadine Emmerich, Marian Grade, Adam Stepniewski
Gunther Felmerer, Dominik Behringer, Adam Stepniewski, Division of Plastic Surgery, Department for Trauma Surgery, Orthopedics and Plastic Surgery, University Medical Center Goettingen, Goettingen 37075, Lower Saxony, Germany
Nadine Emmerich, Georg-August University Goettingen, University Medical Center Goettingen, Goettingen 37075, Lower Saxony, Germany
Marian Grade, Department of General, Visceral and Pediatric Surgery, University Medical Center Goettingen, Goettingen 37075, Lower Saxony, Germany
Author contributions: Felmerer G and Behringer D contributed equally to this work; Felmerer G and Behringer D designed the research study; Felmerer G, Stepniewski A, Grade M and Behringer D performed the surgeries; Grade M contributed in general surgery issues; Behringer D and Stepniewski A analyzed the data and wrote the manuscript; Emmerich N and Behringer D provided figures and tables; all authors have read and approved the final manuscript.
Institutional review board statement: The study was reviewed and approved by the ethics committee of University Medical Center Goettingen, Germany (Approval No. 10/10/14).
Informed consent statement: All study participants, or their legal guardian, provided informed written consent prior to study enrollment.
Conflict-of-interest statement: There are no conflicts of intrest to report.
Data sharing statement: Technical appendix, statistical code, and dataset available from the corresponding author at [adam.stepniewski@med.uni-goettingen.de]. Participants gave informed consent for data sharing and the presented data are anonymized and risk of identification is low.
STROBE statement: The authors have read the STROBE Statement – checklist of items, and the manuscript was prepared and revised according to the STROBE Statement – checklist of items.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Adam Stepniewski, MD, Doctor, Surgeon, Division of Plastic Surgery, Department for Trauma Surgery, Orthopedics and Plastic Surgery, University Medical Center Goettingen, Robert-Koch-Strasse 40, Goettingen 37075, Lower Saxony, Germany. adam.stepniewski@med.uni-goettingen.de
Received: August 17, 2020
Peer-review started: August 17, 2020
First decision: December 21, 2020
Revised: January 2, 2021
Accepted: March 12, 2021
Article in press: March 12, 2021
Published online: April 18, 2021
Research background

Secondary lymphedema after surgery is a progressive, chronic disease that is still not completely curable. Over time a multitude of surgical therapy options have been described with its individual complications and side effects.

Research motivation

Due to technical progress in robot-assisted surgery, many advances have been made in this field within the last few years. This has significantly increased the precision and tissue-sparing work during abdominal interventions and made omental flap harvest much easier. Our motivation was to compare the complications of robot-assisted lymph node transfer in the treatment of secondary limb lymphedema.

Research objectives

Since 2010 we use the autologous supraclavicular lymph node transplantation (VLNT) and the lymph vessel transplantation (LVTx) according to Baumeister. Since 2017 we perform robot assisted free VLNT from the omentum. Our motivation was to summarize and point out the single-center complications in LVTx and free VLNT.

Research methods

In this study, data from three different collectives were collected and evaluated. A total of 87 patients undergoing treatment at our clinic were included. In total n = 18 robot-assisted omental lymph node transplantations, n = 33 supraclavicular lymph node transplantations and n = 36 Lymph vessel transplantations were analyzed. The data collection was performed preoperatively during consultations, as well as three weeks, six months and twelve months after surgical treatment. Descriptive statistics were used to analyze the patient data.

Research results

In the omental VLNT, three patients showed a slight abdominal sensation of tension within the first 12 postoperative days. No other donor side morbidities occurred. Our supraclavicular VLNT collective showed 10 lift defect morbidities with one necessary surgical intervention. In our LVTx collective, 12 cases of donor side morbidity were registered. In one case, surgical intervention was necessary.

Research conclusions

Concerning donor side morbidity, robot-assisted omental VLNT is clearly superior to supraclavicular lymph node transplantation and LVTx.

Research perspectives

At present, only a few publications on robot-assisted VLNT have been published. Because of the short time, no reliable assessment concerning long-term complications can be yet made. The evaluation will have to be clarified in future studies.