Lymphatic Ultrasound Works: Time-efficient Planning and Decision-making for Lymphaticovenous Anastomosis-A Narrative Review With Workflow Analysis.

BACKGROUND

Preoperative lymphatic ultrasound has been increasingly used for lymphaticovenous anastomosis (LVA) to identify suitable lymphatic vessels. The purpose of this study is to quantify the time efficiency of ultrasound-guided LVA.

METHODS

Twenty-four women (41 limbs) undergoing LVA were retrospectively evaluated. Preoperative lymphatic ultrasonography was performed using an 18-MHz linear probe, and a maximum of 4 anastomoses per operation were planned based on ultrasonographic findings. Examination time was recorded and compared between patients with and without prior indocyanine green lymphography. Intraoperatively, the time to identify the recipient veins and lymphatic vessels was recorded.

RESULTS

LVA was performed at 83 sites, with a mean of 2.1 anastomoses per limb (range, 1-4). The mean duration of ultrasonography was 26.4 minutes (range, 16-48 min), with no significant difference between patients with and without prior indocyanine green lymphography (P = 0.077), and no correlation with body mass index (r = -0.057). The mean identification time was 2 minutes 10 seconds for veins and 8 minutes 5 seconds for lymphatic vessels. Lymphatic identification time increased with advancing International Society of Lymphology stage (stage 1, 4 min 53 s; stage 2a, 7 min 21 s; stage 2b, 8 min 27 s; stage 3, 9 min 35 s; P = 0.039), with a significant difference between stage 1 and stage 3 (P = 0.0014).

CONCLUSIONS

Preoperative lymphatic ultrasound enables structured, time-efficient LVA planning and rapid intraoperative identification of lymphatic vessels, even in advanced lymphedema. By quantifying workflow metrics and surgical decision-making, this study supports lymphatic ultrasound as a practical standard for LVA planning.