Intraoperative Real-Time Visualization of the Lymphatic Vessels Using Microscope-Integrated Laser Tomography

Area of Science:

• Vascular Surgery
• Lymphedema Management
• Medical Imaging

Background:

• Accurate detection and selection of lymphatic vessels are crucial for effective lymphaticovenular anastomosis (LVA).
• Existing intraoperative imaging modalities for lymphatic vessels have limitations.
• Laser tomography presents new capabilities for evaluating lymphatic vessels and anastomosis patency.

Purpose of the Study:

• To evaluate the capabilities of intraoperative laser tomography for lymphatic vessel assessment.
• To validate the patency of anastomosis sites using laser tomography.
• To compare the efficiency of laser tomography with ultrasonography for lymphatic vessel scanning.

Main Methods:

• Fifty-two patients with upper extremity lymphedema underwent indocyanine green (ICG) lymphography and real-time laser tomography.
• Laser tomography was used to image ICG-enhanced lymphatic vessels before transection during LVA.
• Scanning time, correlation with histology, and anastomosis patency were assessed.

Main Results:

• Laser tomography clearly visualized the lumen and wall of 132 ICG-enhanced lymphatic vessels.
• Lymphatic vessel scanning was significantly faster with laser tomography (1.6 min) than ultrasonography (4.8 min).
• High correlation was found between laser tomography and histological measurements of lymphatic vessel wall thickness (r=0.977).

Conclusions:

• Microscope-integrated laser tomography provides high-resolution, real-time lymphatic vessel imaging.
• It enables objective evaluation of lymphatic lumen condition and post-LVA anastomosis status.
• This technology aids in surgical decision-making for LVA procedures.