Robotic-assisted lymphovenous anastomosis to treat periorbital lymphedema and systematic review of lymphatic reconstruction of face and neck lymphedema.

Head and neck lymphedema has gained increasing interest due to improved head and neck cancer survival. However, there exist no guidelines on its management so far. The study reports on the first robotic-assisted lymphovenous anastomosis (LVA) in the head and neck region and further systematically reviews the current literature on lymphatic microsurgery in patients with face and neck lymphedema, aiming to analyze the feasibility and efficacy of different reconstructive techniques. The feasibility of robotic-assisted LVA in the face was assessed and clinical outcomes reported. In addition, a systematic review of the current literature on lymphatic reconstruction of head and neck lymphedema was conducted in accordance with the PRISMA guidelines. The review was registered on PROSPERO (CRD420250651455). Robotic-assisted LVA of the periorbital region led to a significant reduction in edema and improved function. The literature search yielded 468 articles, of which 18 articles were deemed eligible for full-text reading, finally resulting in the inclusion of 10 articles. All included studies showed feasibility of lymphatic reconstruction in the head and neck region and achieved alleviation of lymphedema and its symptoms. However, the small number of patients and heterogenous assessment methods of lymphedema made it difficult to draw definite conclusions on the surgical management of head and neck lymphedema. Robotic-assisted lymphatic reconstruction for face and neck lymphedema is a promising microsurgical technique, however further studies are necessary to create guidelines on the management of head and neck lymphedema.