Frequently asked questions about Lymphedema Clinic Tokyo

Frequently asked questions

Q1. What is the size of the skin incision required for surgery?

The width of each incision is 1 to 3 cm.

Because absorbable sutures are used, in principle there is no need to remove the stitches.


Q2. What method of anesthesia is used?

We use local anesthesia, which has been reported to cause much less discomfort, such as postoperative nausea, compared with general anesthesia.


Q3. How many anastomoses are performed in a single surgery?

For safe and effective same-day surgery, we consider that there should not be more than three to four anastomosis sites.

Using the most advanced technologies, such as ultrasound, ICG fluorescence lymphography, lymph scintigraphy, and so on, has made it possible for us to assess the conditions of the lymphatic vessels and veins prior to surgery. Although it was necessary to make ten incisions in the skin with the conventional procedure five years ago, currently, three to four incisions for anastomoses can achieve the same outcome or effect.


Q4. Is a second surgery needed after undergoing LVA (lymphatic venous anastomosis)?

Complete amelioration might not be achieved with just one LVA surgery. In that case, the LVA surgery may be performed several times, depending on the postoperative course. Patients who have recovered after LVA are likely to consider a second LVA as they become more active. In such cases, we usually recommend that the patients schedule the next surgery at least three to four months after the last one.


Q5. Is same-day surgery available to patients with severe lymphedema?

Depending on the present pathological condition, we may need to perform surgery several times for severe lymphedema, while ensuring safety and efficacy.


Q6. What are possible complications?

Complications such as nerve disorders or infections have not occurred in the past five years. The occurrence of minor complications (e.g., the postoperative wound healing poorly, wound dehiscence, and so on) is less than 0.1%.


Q7. Is hospitalization required to undergo surgery? If required, about how long does the patient have to stay?

As a general rule, hospitalization is not necessary. If the patient has a pre-existing condition such as heart disease and needs to stay in the clinic, please consult with us separately. In such cases, the patient will be scheduled to stay for about one to two weeks.


Q8. Are there no risks in same-day surgery without hospitalization? Wouldn’t moving right after surgery put a burden on the legs and lymphatic system?

Analysis of 10 years’ worth of data on patients who had a one-week period of rest and recovery following surgery and patients who returned to their normal lives immediately after surgery showed that those who returned to normal life had better outcomes. That is why the clinic uses same-day surgery.

Even now, other medical institutions sometimes use hospitalization with a period of rest and recovery.


Q9. Is there a high risk in performing liposuction at the same time as LVA surgery? When is liposuction done at Lymphedema Clinic Tokyo?

We recommend waiting one year after LVA surgery before doing liposuction. This is because fat cells naturally shrink after LVA surgery and some patients will therefore not need liposuction. In cases where liposuction is done one year later, it is performed only at locations that will not damage the lymphatic system, after using an ultrasound examination to identify the LVA surgery location and position of lymphatic vessels before surgery*.

* Using an ultrasound examination to identify lymphatic vessels is a leading-edge diagnostic technique developed by us over the past one to two years. We have reported the technique in a medical paper, but it has not yet spread much around the world due to its technical difficulty.


Q10. How many doctors participate in an LVA surgery at Lymphedema Clinic Tokyo? And, how many surgical microscopes do you use?

Only one surgeon, Dr. Mihara, performs the preoperative examination and anastomoses using one state-of-the-art surgical microscope.

Ten years ago, we used to perform LVA surgeries with 10 - 15 anastomosis sites per leg with four operators and four microscopes. Even now, other medical institutions might have several surgeons using several microscopes.

Nowadays, it is possible to obtain better curative effects with fewer incisions. See Q3 for details.


Q11. I would like to receive treatment in Japan. Is it OK for patients with lymphedema or cellulitis to go on a long plane ride? Also, how long do I have to wait until it is safe to get on a plane after surgery?

In general, we recommend that you receive standard complex decongestive physical therapy (CDP) before traveling to Japan. There is no problem with being on a long plane ride if you have had appropriate complex decongestive physical therapy (CDP). You should then be able to fly on a plane about a week after surgery. With regard to cellulitis, please note that if redness or swelling is seen in the affected area and you have a systemic fever of 37.5 degrees or higher, undergoing surgery will be difficult. In that case, you have to get treatment for cellulitis in your country before coming to Japan. Prophylactic oral antibiotics can reduce cellulitis. Thus, patients who experience repeated cellulitis are advised to consult with their doctor and take oral antibiotics.


Q12. Are there any precautions to keep in mind after I return to my home country following surgery in Japan?

According to the analysis of outcomes of LVA surgeries we performed in the past 10 years, patients who gained weight before or after surgery or who did not receive complex decongestive physical therapy were likely to obtain less positive outcomes. Therefore, you need to keep in mind the need for weight control and to undergo complex decongestive physical therapy after a successful surgery. We will conduct online or face-to-face examinations to determine the effect of treatment in two months and six months after surgery. If the treatment is not effective, a second surgery will be considered.


Q13. What is the cost of LVA surgery?

The cost will vary depending on the symptoms. The standard cost of treatment is about 2 to 3.5 million yen. However, if fewer anastomoses are performed, the treatment may be provided at a lower cost. In addition to the treatment, patients are required to pay the cost of interpreters and so on. If traveling to Japan is difficult due to cost or scheduling, it is possible for patients to get just "a second opinion" from us without coming to Japan. Please ask Emergency Assistance Japan Co., Ltd. for more details.


Q14. What should I do to make an appointment for a surgery?

Please first contact our affiliated coordinator, Emergency Assistance Japan Co., Ltd. The staff will explain the required procedures to you.


Q15. The patient is not Japanese and does not speak Japanese at all. Can such a patient receive medical care at Lymphedema Clinic Tokyo?

Yes, this is possible. Our affiliated coordinator, Emergency Assistance Japan Co., Ltd., can arrange interpreter services available in various languages, including English, Chinese, and Russian.

Emergency Assistance Japan Co., Ltd. can provide services such as meeting patients at the airport and taking them to accommodations, as well as interpreting during medical care at health care facilities.


Q16. Can a patient who is not covered by the Japanese National Health Insurance plan receive medical care in Japan?

Yes, this is possible. Patients who are not covered by the public health insurance policy in Japan should contact our affiliated coordinator, Emergency Assistance Japan Co., Ltd.


Q17. The patient is not Japanese but speaks Japanese. Is it still necessary to get an interpreter?

For patients to receive appropriate treatment, they are encouraged to use the medical interpretation service provided by Emergency Assistance Japan Co., Ltd. A number of problems have been reported because international patients did not use professional interpreters for their treatment.


Q18. The patient is living abroad but speaks Japanese. Is it possible to contactLymphedema Clinic Tokyo directly without the intermediation of  Emergency Assistance Japan?

Patients living abroad are required to get in touch with us through Emergency Assistance Japan Co., Ltd.


Q19. Do international patients need a visa to travel to Japan if they want to receive medical care at Lymphedema Clinic Tokyo?

International patients may be required to obtain a visa to travel to Japan in some cases. Emergency Assistance Japan Co., Ltd., as a registered guarantor, helps patients obtain a Visa for Medical Stay.


Q20. I would like to know whether or not I can be treated. What do I have to do?

Please ask Emergency Assistance Japan Co., Ltd. for more details. The medical records or materials listed below can facilitate patients' consultations in many cases.

  1. Blood test: Blood counts, albumin, liver function, renal function, thyroid gland function, lipids, glucose, coagulability, infection (HIV, syphilis, hepatitis B, hepatitis C, etc.)
  2. Chest X-ray
  3. ECG
  4. Ultrasound examination of leg veins or CT scans of the legs
  5. ABI (Ankle Brachial Index)
  6. Lymph scintigraphy


Q21. I am a doctor living abroad. I would like Dr. Mihara to see my patient. What do I need to do?