Optimal Surgical Positions for Lymphaticovenular Anastomosis

In this chapter, surgical positions that can maximize surgical efficiency will be discussed. The large collector lymphatic vessels are often located in the medial aspect of the lower extremity; performing LVA with these lymphatic vessels with the patient in supine or prone position tilts the surgical field to a certain point, rendering the surgery more difficult. Placing the patient in a lateral crisscross position addresses the aforementioned issues. When approaching the lymphatic vessels in the medial aspect of the lower extremity, the patient should be placed in the lateral decubitus position, with the affected lower extremity on the bottom. Performing LVA on the posterior aspect of the proximal forearm and the upper arm can also be very difficult. In these settings, the following position of the upper limb can facilitate the surgical procedures. For incisions in the posterior aspect of the forearm, close to the elbow, the arm should be folded in front of the patient, elevating the upper arm using foam wedges, pillows, and towels. This surgical position significantly facilitates identification of the lymphatic vessels and the veins, thus resulting in shorter operative time, which is also advantageous for both the surgeon and the patient.