Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Case Reports
. 2024 May 14;17(5):e260562.
doi: 10.1136/bcr-2024-260562.

Robot-assisted lymphovenous anastomosis surgery for lymphocele in the groin

Caroline Lilja  1 , Jørn Bo Thomsen  2 , Jens Ahm Sørensen  2
Affiliations
Case Reports

Robot-assisted lymphovenous anastomosis surgery for lymphocele in the groin

Caroline Lilja et al. BMJ Case Rep. .

Abstract

We present the first-in-human robot-assisted microsurgery on a lymphocele in the groin involving a man in his late 60s who had been coping with the condition for 12 months. Despite numerous efforts at conservative treatment and surgical intervention, the lymphocele persisted, leading to a referral to our clinic.Diagnostic techniques, including indocyanine green lymphography and ultrasound, identified one lymphatic vessel draining into the lymphocele. The surgical intervention, conducted with the assistance of a robot and facilitated by the Symani Surgical System (Medical Microinstruments, Calci, Italy), involved a lymphovenous anastomosis and excision of the lymphocele. An end-to-end anastomosis was performed between the lymphatic and venous vessels measuring 1 mm in diameter, using an Ethilon 10-0 suture.The surgery was successful, with no postoperative complications and a prompt recovery. The patient was discharged 3 days postoperatively and exhibited complete recovery at the 14-day follow-up. This case marks the first use of robot-assisted microsurgical lymphovenous anastomosis to address a groin lymphocele, highlighting the benefit of advanced robotic technology in complex lymphatic surgeries.

Keywords: Healthcare improvement and patient safety; Plastic and reconstructive surgery; Surgery; Ultrasonography; Vascular surgery.

PubMed Disclaimer

Conflict of interest statement

Competing interests: None declared.

Figures

Figure 1
Figure 1
The patient presenting with his lymphocele in the left groin, during preoperative planning with indocyanine green lymphography and ultrasound. (A) Lymphocele, (B) the location of the subdermal vein located using ultrasound, (C) the lymph venule running towards the lymphocele, located using indocyanine green lymphography.
Figure 2
Figure 2
The set-up of the two surgeons using the Symani Surgical System (Medical Microinstruments, Calci, Italy) to perform lymphovenous anastomosis on the patient.
Figure 3
Figure 3
Pictures showing the step-by-step process of the anastomosis using the Symani Surgical System (Medical Microinstruments, Calci, Italy), from the first suture until the final anastomosis.
Figure 4
Figure 4
Images from the operation are presented. Above: the lymphovenous anastomosis is illustrated during indocyanine green lymphography. Below: the anastomosis created during the procedure is shown before surgical closure.
Figure 5
Figure 5
14 days postoperatively. The patient presents a full recovery, with no swelling at the groin.
See this image and copyright information in PMC

Similar articles

See all similar articles

References

    1. Nair M, Pisano U, Philippou M, et al. . Management of large post-crossover Inguinal Lymphocele. JVascSocGBIrel 2023;2:118–20. 10.54522/jvsgbi.2023.062 - DOI
    1. Uyulmaz S, Planegger A, Grünherz L, et al. . Lymphovenous anastomoses and microscopic Lymphatic Ligations for the treatment of persistent Lymphocele. Plast Reconstr Surg Glob Open 2021;9:e3407. 10.1097/GOX.0000000000003407 - DOI - PMC - PubMed
    1. Kadota H, Shimamoto R, Fukushima S, et al. . Lymphaticovenular anastomosis for lymph vessel injury in the pelvis and groin. Microsurgery 2021;41:421–9. 10.1002/micr.30741 - DOI - PubMed
    1. Malzone G, Menichini G, Innocenti M, et al. . Microsurgical Robotic system enables the performance of Microvascular anastomoses: a randomized in vivo Preclinical trial. Sci Rep 2023;13:14003. 10.1038/s41598-023-41143-z - DOI - PMC - PubMed
    1. Lindenblatt N, Grünherz L, Wang A, et al. . Early experience using a new Robotic Microsurgical system for Lymphatic surgery. Plast Reconstr Surg Glob Open 2022;10:e4013. 10.1097/GOX.0000000000004013 - DOI - PMC - PubMed

Publication types