A world first on a young 19-year-old patient: the Montpellier University Hospital has achieved a feat in microsurgery

Professor Herlin's plastic surgery department aims to become an expert center in lymphedema surgery. FREE MIDI – SYLVIE CAMBON

At the Montpellier University Hospital, the team from the plastic surgery department of Professor Christian Herlin has developed a technique which makes it possible to restore the flow of lymph towards the venous sector by unclogging the lymphedema from vessels of less than 0.1mm. The procedure carried out on a 19-year-old patient is a world first!

It is a surgical feat which was carried out on a young patient in the lymphology department of the Saint-Eloi hospital of the Montpellier University Hospital.

Intervention on vessels with a caliber less than 0.5 mm constitutes in itself a performance of surgical skill, but when it is done acts as an "anastomosis" (connection of vessels to each other)  on vessels of less than 0.1 mm, -0.07 mm exactly-, we are in a feat, even the first in the world.

An infinitely small operation that takes six times as long

"The gestures are infinitely small, without a robot, and with bare hands", explains Professor Christian Herlin, author of this operation which took him "six times more time", carried out in January on a 19-year-old patient years old suffering from "lymphedema". The glass ceiling being 0.15 mm, "we halved it".

When lymph cannot circulate normally and it accumulates in the tissues of a limb, lymphedema appears, in the form of lymphatic inflammation. swelling caused by abnormal accumulation of this fluid. Most of the time, in parts of the body that have undergone lymph node dissection, or in reaction to radiotherapy. "Suffering from cancer of the shoulder blade, the treatment damaged his lymphatic system.

Notable improvements

Current treatments aim to reduce and slow the development of edema through lymphatic drainage, compression bandages and restraint, "it's medicine palliative, which is not yet completely curative, if it does not completely cure people, it restores a flow, removes the disability and the symptoms. An improvement on his arm was noted on fluoroscopy. The lymphatic vessels were functioning.

France still too timid in microsurgery

So this is a world first, but "I'm not the best microsurgeon in the world!", jokes Christian Herlin."They are in Korea. In France, it is not yet valued enough as in Asia where there is this dimension of exploit, of self-fulfillment. In France, face transplantation has transformed things a little, because we are in a spectacular achievement. We now have equipment, with x45 magnification microscopes and 0.1 mm forceps. But a simple pliers costs 4,000 euros, the precision allows you to go very small." 400,000 € this is the price of the microscope and for each suture, it is 200 € !

Montpellier, European center of excellence

"In Montpellier, we are best placed to develop this very exceptional lymphedema surgery, we are a reference center in lymphology in France and we has a very large breast surgery center with the ICM. The demand is high, at early stages. In Europe, it is also practiced in Brussels, Rome or Barcelona". Montpellier is therefore one of the rare centers of ;European excellence!

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