Lymphedema Risk-Reduction Surgery: the TLAR Approach – what is it?
A new technique, initiated and described by Jaume Masià, MD, Barcelona in 2014, of surgical prevention and risk reduction of lymphedema. It is a kind of improvement of the LYMPHA by Boccardo technique.
It can be applied to patients qualified for axillary lymphadenectomy (removal of axillary lymph nodes) for breast cancer.
What does it consist in?
In a patient eligible for axillary lymphadenectomy, the lymphatic pathways from the upper limb area on the operated side are marked – axillary reverse mapping (ARM). The axillary lymph nodes are then removed. If, during the removal process, it is found that the lymphatic drainage of the hand has to be disrupted – the lymphatic vessels running from the hand are dissected and anastomosed to the veins – a prophylactic LVA (lymphatic-venous anastomosis) is performed
It is the most modern technique of surgical prevention of lymphedema in the world. The risk with routine lymphadenectomy amounts to 30-40%, whereas after the TLAR technique it amounts to 4-5%. Thanks to this technique there is an 8-10 times risk of reducing lymphoedema on the operated side.
Where is it performed?
Currently, at the Regional Hospital in Slupsk, this technique is routinely performed in all patients eligible for axillary lymphadenectomy for breast cancer.
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