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Seki et al. Plast Aesthet Res 2021;8:44 Plastic and
DOI: 10.20517/2347-9264.2021.74
Aesthetic Research

Opinion Open Access

Fundamental and essential techniques for
supermicrosurgical lymphaticovenular anastomosis:

the art of Isao Koshima’s supermicrosurgery

Yukio Seki, Akiyoshi Kajikawa
Department of Plastic and Reconstructive Surgery, St. Marianna University School of Medicine, Kawasaki, Kanagawa 216-8511,
Japan.

Correspondence to: Dr. Yukio Seki, Department of Plastic and Reconstructive Surgery, St. Marianna University School of
Medicine, 2-16-1 Sugao, Miyamae-ku, Kawasaki, Kanagawa 216-8511, Japan. E-mail: yukioseki.pla@gmail.com

How to cite this article: Seki Y, Kajikawa A. Fundamental and essential techniques for supermicrosurgical lymphaticovenular
anastomosis: the art of Isao Koshima’s supermicrosurgery. Plast Aesthet Res 2021;8:44. https://dx.doi.org/10.20517/2347-
9264.2021.74
Received: 21 Jun 2021 First Decision: 26 Jul 2021 Revised: 4 Aug 2021 Accepted: 24 Aug 2021 First online: 26 Aug 2021

Academic Editors: Matthew L Iorio, Isao Koshima Copy Editor: Yue-Yue Zhang Production Editor: Yue-Yue Zhang

Abstract
Lymphaticovenular anastomosis (LVA) is a highly effective, minimally invasive surgical treatment for lymphedema.
The effect of LVA appears immediately after the creation of lymph-to-venous pathway. However, the long-term
outcome of LVA is not always promising when the lymph-to-venous anastomosis has any potential risk of
occlusion. The reasons of postoperative LVA occlusions are considered both a technical matter in performing LVA
and a strategic matter in preoperative planning. This report focuses on intraoperative techniques of LVA to avoid
postoperative occlusions. Depending on the types of undesirable surgical procedures, lymphaticovenular
anastomoses are at risk of future occlusions in early, mid-, or late-postoperative course. The authors describe
fundamental and essential techniques to perform supermicrosurgical LVA, and the true concept of Isao Koshima’s
supermicrosurgery, in which the pith and marrow of the doctrine is not only the way of handling the small vessels
or needles, but also the surgeons’ skills to feel intima of the vessels and lymphatic flow itself.

Keywords: Lymphedema, lymphaticovenular anastomosis, supermicrosurgery, one hand suture technique, surgery

© The Author(s) 2021. Open Access This article is licensed under a Creative Commons Attribution 4.0
International License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, sharing,
adaptation, distribution and reproduction in any medium or format, for any purpose, even commercially, as
long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and
indicate if changes were made.

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