What is supermicrosurgery?

Microsurgery describes surgery performed beyond the limits of human sight utilising the operating microscope. Supermicrosurgery takes this concept further, joining together vessels of between 0.2mm and 0.8mm in diameter, using sutures that are thinner than a human hair. This surgery requires high magnification, specialised equipment, and specialist technical expertise and training.

How is supermicrosurgery used in the treatment of lymphoedema?

At the Oxford Lymphoedema Practice, we use the most advanced minimally invasive supermicrosurgical techniques to relieve lymphoedema. Through tiny incisions, often less than 2cm (1 inch) in length, we find lymphatic channels and small veins just beneath the skin. We then connect the lymphatic channels to the veins, using sutures that are less than a fifth the width of a human hair. This gives the lymphatic fluid an alternative route to escape from the affected area, effectively bypassing the area of damage to the lymphatics.

Where was supermicrosurgery pioneered?

Supermicrosurgery was pioneered by Professor Isao Koshima in Japan. Professor Furniss and Mr Ramsden have travelled to Japan to train in these specialist techniques with Professor Koshima and his team. Professor Furniss has co-authored three peer-reviewed academic papers on supermicrosurgical techniques in the treatment of lymphoedema with the team in Japan. Dr Makoto Mihara from Tokyo also visited the Oxford Lymphoedema Practice in early 2014, further strengthening the links between our practices. In late 2014, Professor Furniss also visited Professor Campisi in Genoa, another of the pioneers of lymphaticovenular anastomosis surgery, to observe him operating, and to discuss in depth the management of patients with lymphoedema. 

A lymphaticovenular anastomosis. Note the lymphoedema fluid (dyed blue) has already started flowing into the vein, relieving the lymphoedema.

Mr Ramsden with Professor Koshima in Tokyo

Professor Furniss with Professor Campisi in Genoa