Husam H. Balkhy, MD
AT THE FOREFRONT OF SURGERY
David W. Chang, MD
LYMPHOVENOUS BYPASS
ROBOTIC CARDIAC SURGERY
Microsurgical Technique for Lymphedema
Robot-assisted Procedures Speed Recovery
As many as 25 to 30 percent of women who have breast cancer surgery with lymph node removal and radiation therapy develop lymphedema. While there is no cure, lymphovenous bypass and lymph node transfers can be effective in relieving pain, swelling and discomfort. Plastic and reconstructive surgeon David W. Chang, MD, was instrumental in refining the microsurgical technique and is one of only a few surgeons in the country who routinely perform the procedure. The surgery begins with an injection of green dye that acts as a fluorescent marker to illuminate lymphatic vessels and backed-up fluid sites. Chang views them with a sophisticated infrared camera. “It’s like looking through night vision goggles,” he said. Chang first marks visible lymphatic pathways on the skin. Looking through the microscope, he then makes small incisions to reach lymphatic vessels and tiny veins close by. He cuts the vessels and veins with microsurgical instruments and sutures them to create the bypass. Swelling
is reduced as lymph flows into the bloodstream. Chang cautions patients that the surgery isn’t “a magical solution.” But many see improvement, and the affected limb often feels lighter and more comfortable. “Before we had these skills and tools, there wasn’t much to do for lymphedema,” said Chang, who came to the University of Chicago Medicine from the University of Texas MD Anderson Cancer Center in Houston. “Now there are options for these patients.” Chang and colleagues studied 100 consecutive patients who had lymphovenous bypass surgery:
The University of Chicago Medicine is one of a handful of hospitals in the U.S. offering a wide range of robot-assisted surgical approaches for cardiac conditions. Leading the program is Husam H. Balkhy, MD, an internationally recognized expert who has performed hundreds of these procedures with excellent outcomes. Balkhy specializes in robotic surgery for atrial fibrillation, mitral and tricuspid valve repair, atrial septal defect closure and coronary artery bypass. He is one of just a few cardiac surgeons in the country performing totally endoscopic coronary artery bypass (TECAB) surgery.
» Overall, surgery reduced the excess volume of affected limbs by 33 percent after three months, 36 percent after six months, and 42 percent after one year.
» Patients with stage 1 or 2 lymphedema had significantly better outcomes than those with more advanced stages.
» Surgery on arms was more effective than on legs.
For more information, visit uchospitals.edu/ david-chang.
AT THE FOREFRONT
ROBOTIC CARDIAC SERVICES INCLUDE:
» Surgical therapy for AFib
» Mitral/tricuspid valve repair
» Closure of atrial septal defect
» Totally endoscopic
Stephen Hood, of Orland Park, Ill., recently underwent TECAB and was surprised at how quickly he recovered. “I had no pain at all and was back to riding my bike in two weeks and to work in just five weeks,” said the 65-year-old, remarking that he took only over-the-counter medications for slight discomfort. “TECAB is appropriate for patients who, like Stephen, have disease in the left coronary system involving three or fewer arteries,” said Balkhy, director of robotic and minimally invasive cardiac surgery. “If the condition is diffuse or involves more than three coronary arteries, we offer a hybrid approach that entails putting stents in the arteries that are difficult to reach robotically.” Cardiac surgeons and interventional cardiologists perform hybrid procedures in operating suites specially equipped for complex surgery and cardiac catheterization.
For more information, visit uchospitals.edu/ husam-balkhy.
coronary artery bypass (TECAB)
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