“We believe that New Zealanders who beat cancer should not be resigned to a life sentence of lymphoedema.”
The National Lymphatic Surgery Service is the result of collaboration between surgeons, lymphoedema therapists and industry partners. Our goal is to bring modern lymphoedema reconstructive surgery to New Zealand. By leveraging the latest in surgical science and technology, there is now hope that cancer lymphoedema could eventually be a thing of the past.
In addition to arteries and veins, the body has a parallel system of microscopic tubes known as lymphatics. These collect excess body fluid from tissues, returning it towards the heart and back into circulation. En-route, the fluid is filtered by lymph nodes, which are part of the immune system.
Lymphoedema is a condition caused by fluid collecting and stagnating in body tissues, due to back-pressure from blocked or non-functional lymphatics. In “primary lymphoedema”, people are born with faulty lymphatic systems. However, most adult lymphoedema is “secondary lymphoedema”, due to damaged normal lymphatics. In New Zealand, the most common cause is removal of lymph nodes for cancer treatment, especially breast, gynaecological, and skin cancer. Trauma and parasite infections are also recognised causes.
Symptoms, which may manifest months or even years later, typically worsen over time. These include:
- Limb swelling
- Changes in skin quality, and hardening of tissues
- Heaviness
- Pain or tightness
- Increased susceptibility to infection
Our initial offering will be lymphovenous anastamosis (LVA). This is a technique which redirects fluid around damaged lymphatics. It is achieved through minimally invasive surgery under local anaesthesia, using special microsurgery tools and techniques. Surgery is in-and-out, with no hospital stay required. LVA is best suited for patients with early disease, where their limb volume can still be normalised with compression garments. When performed in correctly selected patients, LVA can improve limb volume, reduce pain, prevent infection, and slow disease progression.
As our capacity and capability matures, we will be offering other types of surgery. These techniques are suited to the needs of different patients.
Vascularised lymph node transfer (VLNT) is used in similar circumstances to LVA, but when LVA is not technically feasible. It involves transplanting healthy lymph nodes and lymphatics from another part of the body into the affected limb. This is a longer, more involved operation that requires a multi-day hospital admission.
For those with more advanced lymphoedema, where compression can no longer reduce a limb to a normal volume, liposuction is a proven treatment. It offers excellent results in terms of volume reduction, improved pain and reduced infection risk. Again, this is a longer operation requiring hospital admission and significant dressing requirements.
Lymphoedema surgery complements the non-surgical therapies delivered by qualified lymphoedema therapists. Without having these treatments in place, patients risk having an underwhelming surgical result. For this reason, we require patients to be referred by either their medical practitioner or lymphoedema therapist. We need details of your past medical history, cancer treatment, and confirmation that you have been compliant with your lymphoedema therapy for at least 6 months.
Please note that we do not receive funding from Te Whatu Ora / Health NZ, and that this is presently a privately funded service. We have worked with all major health insurance providers, who have agreed to approve treatment funding on a case-by-case basis. We hope to eventually establish a formal, inclusive funding pathway for multidisciplinary care, and are actively advocating towards this.
