Lymphatic venous anastomosis (LVA) under local anesthesia

Minimally invasive treatments

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.

Lymphatic venous anastomosis (LVA) under local anesthesia

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.

Prevention Cellulitis for Lymphedema patients

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.

LVA (Lymphatic Venous Anastomosis), Lymphedema Treatment Japan by Dr. Makoto Mihara
LVA (Lymphatic Venous Anastomosis), Lymphedema Treatment Japan

[ 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. 


Treatment Cost

📞 Contact us: [Emergency asistance japan co. ] Please do not hesitate to contact EAJ Co., Ltd. if you are considering Dr. Mihara's surgery. Surgecal Fee (for example); Online consultation; 500 US dollars (within 60min.) Upper limb; 15,000 -25,000 US dollars (average; 21,000 US dollars) Lower Limb (hemilateral); 20,000 -28,000 US dollars (average; 24,000 US dollars) Lower Limb (bilateral); 23,000 -30,000 US dollars (average; 27,000 US dollars)

Our presentation video

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.