A minimally invasive medical procedure is an examination or treatment in which the impact on the body is reduced as much as possible. In our clinic, we perform lymphatic venous anastomosis, lymph node transplantation, liposuction, or radical surgery for elephantiasis, depending on each individual patient's pathological condition. Our medical care team performs operations on more than 400 cases (limbs) every year, which is the highest number in the world. No moderate or severe complications have occurred in the last five years, and the occurrence of relatively minor complications such as wound dehiscence is less than 0.1%. Patients should feel comfortable and at ease to undergo surgery.

We perform one or two surgeries daily. Privacy is ensured so patients and their families do not encounter each other. The clinic staff, waiting room, operating room, and recovery room are prepared to greet just you (the patient and their family members/companions) on preoperative outpatient visits and surgery day. We offer hospitality by being courteous and flexible in providing an exclusive clinic just for you.

When lymphedema-related cellulitis occurs, it damages your own lymph vessels and worsens your lymphedema. As lymphedema worsens, the frequency of cellulitis increases, and the rate of worsening of lymphedema increases.

Therefore, it is important to prevent the occurrence of cellulitis in order to stop the worsening of lymphedema. Appropriate treatment (conservative therapy and lymphovenous anastomosis) can prevent the occurrence of cellulitis.

Preventing the occurrence of cellulitis allows patients to live a healthy and happy life. At our clinic, we help lymphedema patients live a life with peace of mind.

[ Translation of the video narration ]

Lymphatic vessels and veins are identified using indocyanine green (ICG) fluorescence lymphography and a device to visualize subcutaneous veins (StatVein™) prior to the surgery. Subsequently, the skin incision site is determined and lymphatic venous anastomosis is performed under local anesthesia. The white object that appears first is the index finger of the surgeon. As you can see by comparison with it, the width of the skin incision is 1 to 2 cm, and collecting lymphatic vessels are found in the subcutaneous fat. The white, transparent vessels (above) are lymphatic vessels. We then look for subcutaneous veins (below).

The lymphatic vessels are filled with lymph and are white in color. Because blood travels through veins, they are red in color. We anastomose lymphatic vessels and veins of around 0.5 mm or less with the world's thinnest 12-0 nylon thread under a surgical microscope. The thickness of the thread is about one-tenth of a human hair. The anastomosis is finished when the entire circumference is sutured with four or five stitches. After the anastomosis, we need to make sure that lymph is properly flowing into the vein. A red vein changes color to white when lymph flows into it. Finally, we complete the surgery by closing the wound.

(Note) Currently, it takes about 30 to 40 minutes for us to anastomose one site, and the location and number of anastomoses will vary depending on each individual patient's pathological condition. In general, more anastomoses are required for patients with reduced liver function. 

＜Clear, Transparent, and Designed for Your Peace of Mind＞ We understand that traveling abroad for medical treatment can feel overwhelming, especially when it comes to understanding the costs. To ensure that every international patient feels secure and confident, we provide full transparency in our pricing and take the time to explain each component clearly. The fees listed below reflect the total surgical costs for LVA procedures performed by our highly experienced team, led by Dr. Makoto Mihara — one of the world’s most accomplished LVA surgeons.

🔹 Online Consultation — 50,000 JPY (60–90 min.) Before planning your trip to Japan, we offer a comprehensive online consultation. During this session, we review your medical history, imaging results, symptoms, and treatment goals. You will receive a personalized treatment plan, and all your questions will be answered thoroughly.

🔹 Surgical Fees (All prices in USD) These fees include the LVA surgery itself, the use of advanced imaging (lymphatic ultrasound / ICG lymphography), surgical materials, and postoperative care during your stay in Japan.

＜Upper Limb Lymphedema＞ Range: 15,000 – 25,000 USD Average: 21,000 USD

＜Lower Limb (Unilateral)＞ Range: 20,000 – 28,000 USD Average: 24,000 USD

<Lower Limb (Bilateral)> Range: 23,000 – 30,000 USD Average: 27,000 USD

<Why the Price Range Exists> The final cost depends on the number of LVA anastomoses, the severity of the lymphedema, and whether additional imaging or procedures are required. We always explain the estimated cost before your arrival, so there are no surprises.
<What the Fees Include> ✔ Preoperative assessment during your stay ✔ High-resolution lymphatic ultrasound ✔ ICG lymphography ✔ LVA surgery under local anesthesia ✔ Daily postoperative follow-up ✔ Unlimited email consultation before and after surgery ✔ Compression garment evaluation (PicoPress)
No hidden fees. No unexpected charges. We believe in ethical, transparent, and patient-centered pricing.
<Our Promise to You> Patients from more than 20 countries have chosen our clinic because of our safety record, our detailed explanations, and our commitment to supporting every patient from start to finish. If you have any concerns, we will answer them one by one, with patience and honesty. Clarity creates trust — and your peace of mind is our priority.

📞 Contact us: [Emergency asistance japan co. ] https://emergency.co.jp/english/

We provide online consultations for international patients considering LVA surgery for lymphedema.

Before traveling to Japan, we carefully review imaging studies performed in your home country, including lymphoscintigraphy and lower-limb venous ultrasound, to rule out conditions such as deep vein thrombosis (DVT) and venous disease.

Based on these findings, we explain whether LVA surgery is likely to provide meaningful benefit or whether surgery is not recommended.

We also discuss the importance of weight management, appropriate conservative therapy, and realistic expectations.

This page explains our transparent, evidence-based approach to evaluating international patients and preparing for treatment in Japan.

【How We Evaluate and Prepare International Patients for LVA Surgery】

A transparent, evidence-based approach for patients traveling to Japan

At our clinic, we regularly care for patients with lymphedema from outside Japan.

We believe that clear communication, careful pre-operative evaluation, and realistic expectations are essential—especially when patients are considering treatment abroad.

Below, we explain how we evaluate international patients, how we decide whether LVA surgery is appropriate, and how we prepare together before your visit to Japan.

【Pre-consultation Evaluation in Your Home Country】

Before traveling to Japan, we ask patients to undergo appropriate examinations in their own country, such as:

Lymphoscintigraphy

Lower-limb ultrasound (as applicable)

These test results are reviewed during an online consultation.

During this consultation, we explain:

Whether LVA surgery is likely to be appropriate

What level of benefit may reasonably be expected

The limitations and uncertainties of surgical treatment

This allows you to understand your options before making any travel arrangements.

【Honest Recommendations Based on Expected Benefit】

At our clinic, we do not recommend surgery simply because it is technically possible.

If LVA surgery appears likely to provide meaningful benefit, we will clearly explain why we recommend it.

If we believe that meaningful benefit is unlikely, we will tell you openly during the online consultation that we do not recommend LVA surgery.

This decision is based on medical findings, current evidence, and our clinical experience.

Not recommending surgery is considered an important part of responsible medical care.

【Weight Management Before Surgery: An Essential Factor】

From the time of the online consultation until surgery, we ask patients to focus on weight control, as this strongly influences treatment outcomes.

Our general goal is to aim for your body weight around age 30, if feasible.

Patients with stable and well-controlled body weight tend to have better surgical outcomes.

Weight control is considered essential to achieve the best possible results from LVA surgery.

For patients whose body weight has not increased over time, unnecessary weight loss is not required.

The goal is stability and long-term sustainability, not excessive dieting.

【Active Lifestyle Is Encouraged】

We strongly encourage patients to maintain an active lifestyle, including regular walking and other appropriate physical activities.

Physical activity supports:

Lymphatic function

Weight control

Long-term symptom management

Activity is not discouraged—in fact, it is an important part of comprehensive lymphedema care.

【Evaluation of Conservative Therapy During Your Visit】

When you visit our clinic in Japan, we carefully review whether your current conservative treatment is optimal.

This includes:

Assessment of compression therapy

Evaluation using Picopress to measure actual compression pressure

Ultrasound examination to assess tissue and lymphatic conditions

As a general guideline, we aim to select medical compression stockings that do not worsen swelling even after walking approximately 7,000 steps.

【Compression Stocking Selection During Your Stay in Japan】

During your stay in Tokyo:

You will be asked to walk 7,000 steps or more per day, including sightseeing

Step counts can be monitored easily using a smartphone pedometer

We assess whether swelling worsens after walking

Based on this real-world evaluation:

We determine the most appropriate compression pressure

We prescribe medical compression stockings accordingly

You will wear these stockings for several days before returning home, allowing us to confirm that they are well tolerated and effective.

【Length of Stay in Japan】

For most international patients, the planned stay in Japan is approximately:

10 to 14 days

This allows sufficient time for:

Clinical evaluation

Surgery (if indicated)

Post-operative observation

Adjustment of compression therapy

【Our Philosophy】

Our goal is not simply to perform surgery, but to help patients make well-informed decisions based on medical evidence and realistic expectations.

We believe that:

Appropriate patient selection

Honest communication

Long-term management strategies

are essential for meaningful and sustainable outcomes in lymphedema care.

LVA Surgery for International Patients

Frequently Asked Questions (FAQ)

Q1. Can I have an online consultation before traveling to Japan?

A.

Yes. We provide online consultations for patients living outside Japan.

Before the consultation, we ask you to undergo appropriate examinations in your home country, such as:

Lymphoscintigraphy

Lower-limb ultrasound examination

During the online consultation, we review these results and explain:

Whether LVA surgery may be appropriate

What level of benefit may reasonably be expected

The limitations and uncertainties of treatment

This allows you to make an informed decision before planning your trip.

Q2. What is a lower-limb ultrasound examination, and why is it necessary?

A.

The lower-limb ultrasound examination refers to a venous ultrasound study of the legs.

Its main purpose is to rule out other causes of leg swelling, including:

Deep vein thrombosis (DVT)

Chronic venous insufficiency

Varicose veins

Lymphedema is a diagnosis that should be made after excluding venous causes of swelling.

If swelling is primarily caused by venous disease, LVA surgery is not appropriate, and other treatments should be considered.

Q3. Will you always recommend LVA surgery if it is technically possible?

A.

No.

At our clinic, we do not recommend surgery simply because it is technically feasible.

If LVA surgery is likely to provide meaningful benefit, we will explain why we recommend it.

If we believe that meaningful benefit is unlikely, we will clearly explain during the online consultation that we do not recommend LVA surgery.

Not recommending surgery is considered an essential part of responsible medical care.

Q4. Why might LVA surgery not be recommended?

A.

LVA surgery may not be recommended if:

Lymphatic flow obstruction is not demonstrated on imaging

Swelling is mainly caused by venous disease or other conditions

Body weight is continuing to increase

Appropriate conservative therapy is not being followed

In these situations, surgery is unlikely to provide sufficient benefit.

Q5. Why is weight management important before LVA surgery?

A.

Body weight significantly influences the outcomes of lymphedema treatment.

We ask patients to focus on weight control from the time of the online consultation until surgery.

Our general goal is to aim for body weight around age 30, if feasible

Stable weight control is associated with better surgical outcomes

Weight control is considered essential to maximize the effectiveness of LVA surgery

If your body weight has not increased over time, unnecessary weight loss is not required.

Q6. Should I avoid physical activity before surgery?

A.

No.

We actively encourage an active lifestyle, including walking and other appropriate exercise.

Physical activity helps:

Support lymphatic function

Maintain body weight

Improve long-term symptom control

Activity restriction is generally not recommended.

Q7. What happens to my current conservative treatment when I visit Japan?

A.

During your visit, we carefully evaluate whether your current conservative therapy is optimal.

This includes:

Review of compression therapy

Measurement of actual compression pressure using Picopress

Ultrasound assessment of tissue and lymphatic conditions

We look for ways to optimize conservative care, not only surgical treatment.

Q8. How do you determine the appropriate compression stocking?

A.

As a practical guideline, we aim to select medical compression stockings that do not worsen swelling even after walking approximately 7,000 steps.

During your stay:

You will walk 7,000 steps or more per day, including sightseeing in Tokyo

Step counts can be monitored using a smartphone pedometer

We assess changes in swelling after walking

Based on this real-life evaluation, we prescribe compression stockings with the most appropriate pressure.

Q9. Will I receive compression stockings before returning home?

A.

Yes.

You will wear the prescribed compression stockings for several days during your stay in Japan.

We confirm that:

Swelling does not worsen

The stockings are comfortable and sustainable

Only after confirming these points do we recommend continuing the same compression therapy after returning home.

Q10. How long do I need to stay in Japan?

A.

For most international patients, the planned stay is approximately:

10–14 days

This allows time for:

Evaluation

Surgery (if indicated)

Post-operative observation

Compression therapy adjustment

Q11. Can LVA surgery cure lymphedema?

A.

No.

LVA surgery is not a curative treatment for lymphedema.

It is intended to:

Reduce symptoms

Lower the risk of cellulitis

Decrease the long-term burden of daily management

Lymphedema requires ongoing, long-term care even after surgery.

Q12. What is your clinic’s overall philosophy?

A.

Our goal is not simply to perform surgery, but to help patients make well-informed decisions.

We emphasize:

Careful patient selection

Transparent explanation of benefits and limitations

Long-term management strategies

We believe this approach leads to safer, more meaningful, and more sustainable outcomes.

We had a presentation in academic meeting. We show it. You can understand our concept of lymphedema treatment deeply.

Medical evidence is very important for you and us.

LVA (Lymphatic venous anastomosis) prevent cellulitis associated lymphedema. European Society Lymphoglogy 2014 in Genoa, Italy

Pathophysiology of cancer related lymphedema.   European Society of Lymphology 2014 in Genoa.