How to Dissect Lymphatics under Loupes for Line Production System for Multiple Lymphaticovenular Anastomosis

T. Eldahshoury, Shuhei Yoshida, I. Koshima, Hirofumi Imai, Toshio Uchiki, Ayano Sasaki, S. Nagamatsu, K. Yokota
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Abstract

Abstract Background A surgical line production system using loupes to dissect lymphatics and veins is a cost-effective way of performing multiple lymphaticovenular anastomoses. There is an art to successful dissection of lymphatics under loupes, and selection of the correct loupe magnification is important. Therefore, the aim of this study was to provide a detailed description of how to dissect lymphatics under loupes. Patients and Methods Dissection of lymphatics under loupes was performed for a series of 13 patients. Lymphatics are transparent threadlike structures that are arranged longitudinally and may be oriented with feeding capillary vessels. At the start of dissection, it is helpful to have a reference scale in the field of vision when operating to appreciate the size of the structures seen under loupes. It is also helpful to be able to separate lymphatics from fat tissue in the background. Results Mean time for exploration under loupes was 25 ± 7 minutes; lymphatics were successfully found in 27 sites (90%) of the 30 attempted with failure to identify lymphatics in three sites (10%) and failure to identify veins in three sites (10%); the average size of the lymphatics was found to be 0.5 ± 0.2 mm. No lymphatics could be found by the microscopes after loupes exploration in two sites. Discussion Even a novice surgeon can identify lymphatics based on knowledge of the visual characteristics of these structures. However, a higher magnification is likely necessary for accurate discrimination.
如何为多淋巴结吻合的生产线系统解剖百叶窗下的淋巴管
摘要背景 使用百叶窗解剖淋巴管和静脉的外科生产线系统是进行多个淋巴结-淋巴结吻合的一种成本效益高的方法。在放大镜下成功地解剖淋巴管是一门艺术,选择正确的放大镜是很重要的。因此,本研究的目的是详细描述如何在百叶窗下解剖淋巴管。患者和方法 对13名患者在百叶窗下进行了淋巴管切开术。淋巴管是透明的线状结构,纵向排列,可以与进食的毛细血管一起定向。在解剖开始时,在手术时,在视野中有一个参考量表,以了解在放大镜下看到的结构的大小是有帮助的。能够在背景中从脂肪组织中分离淋巴管也是有帮助的。后果 休假期间的平均探索时间为25 ± 7. 分钟在30个尝试中,27个部位(90%)成功发现淋巴管,其中3个部位(10%)未能识别淋巴管,3个部位未能识别静脉(10%);淋巴管的平均大小为0.5 ± 0.2mm。在两个部位进行检查后,显微镜未发现淋巴管。讨论 即使是新手外科医生也可以根据这些结构的视觉特征来识别淋巴管。然而,更高的放大倍数可能是准确辨别所必需的。
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