Abstract
Background The lymphovenous anastomosis (LVA) has become one of the treatment options for lymphedema.
However, it is regarded as a difficult surgery that many young microsurgeons are reluctant
to try. This report investigates the learning curve in regard to symptom improvement.
Methods This is a retrospective analysis performed in 33 consecutive lymphedema patients
(38 extremities) who underwent only LVAs from August 2010 to February 2016. Surgical
outcomes in regard to surgeon's experience were evaluated. The surgeons experience
was divided into three groups: early group with less than 2 years, moderate with 2
to 4 years, and mature group with more than 4 years of experience.
Results A total of 31 limbs (8/8 in upper extremity and 23/30 in lower extremity) showed
improvement. When we compare volume change and recurrence of cellulitis with regard
to surgeon's experience, there were no statistically significant differences. However,
the mean time per LVA was significantly decreased as the experience increased over
time (p = 0.017).
Conclusion LVA is an effective treatment option to reduce the volume in the affected limb and
to improve symptoms involved. Regardless of the number and experience of the surgeons,
cellulitis improves significantly after LVA. The experience of the surgeon does not
significantly impact the positive outcome while proficiency increases with experience.
Keywords
lymphedema - lymphovenous microanastomosis - learning curve
