The 2nd Symposium on Reconstructive Lymphatic Surgery and Lymphology was opened by Dr. Béla Merkely, Rector of Semmelweis University and Director of the Városmajor Heart and Vascular Center. The Reconstructive Lymphatic Surgery Profile – the first of its kind in Hungary – was launched at the center in 2022 and provides complex lymphatic surgery procedures at a high standard. As a national and international center of lymphatic vessel research, we can open new research directions in the field of surgical and rehabilitation technologies, the rector emphasized in his speech. As he recalled, some of the lymphatic surgery was already present in Hungary 50 years ago due to the pioneering work of Professors Péter Gloviczki and Géza Tasnádi.
Professor Gloviczki, starting from our Városmajor Heart and Vascular Center, became the Hungarian-born vascular surgeon with the most successful career, and later introduced these operations at the Mayo Clinic. Today we perform these procedures in the operating room named after him, with world-class technical facilities. – Dr. Béla Merkely
He stressed that the aim of the symposium was to bring together professionals working in this field to seek ways to collaborate more effectively and optimize care. Regarding the international collaborations, he said that the university worked in academic and clinical cooperation with the Göttlicher Heiland Hospital in Vienna, which had the largest number of lymphedema surgery patients in Europe.
One of the special professional highlights of the event was a workshop held by Dr. Jean-Paul Belgardo, Professor at the Université libre de Bruxelles: He used an infrared camera to demonstrate the healthy and pathological appearance of superficial lymphatic vessels, as well as imaging tools to prove the efficacy of a lymphedema reconstruction surgery performed earlier at Semmelweis University’s Reconstructive Lymphatic Surgery Profile.
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At the beginning of the international section, Dr. Péter Sótonyi, Professor of the Department of Vascular and Endovascular Surgery at the Városmajor Heart and Vascular Center, introduced the first speaker: Dr. Péter Gloviczki, Semmelweis Budapest Award-winning, world-renowned vascular surgeon and Professor Emeritus at the Mayo Clinic in the United States. Dr. Péter Gloviczki’s presentation addressed the challenges in diagnosing and treating lymphedema, a chronic condition involving fluid accumulation, inflammation, and fibrosis in subcutaneous tissues. He presented the causes of the disease and highlighted the importance of early intervention. Dr. Péter Gloviczki mentioned that diagnostic methods, in addition to physical examinations, included advanced imaging techniques such as indocyanine green lymphography, ultra-high frequency ultrasound, and magnetic resonance (MR) lymphangiography. Imaging techniques have evolved considerably and now enable an earlier, accurate diagnosis and an effective treatment plan.
“The most commonly used imaging technique for the diagnosis of lymphedema is lymphoscintigraphy. This is also one of the first-line methods of choice according to the recently adopted consensus of the International Society of Lymphology, but thanks to technical advances, other modalities are also available that are more sensitive in some respects,” he stressed.
Dr. Péter Gloviczki added that in the case of uncertain diagnoses or when setting up a surgical plan, the use of advanced imaging techniques such as ultra-high frequency ultrasound and near-infrared fluorescence imaging, in addition to scintigraphy, was particularly important. These tools provide detailed insights into the dysfunctions of the lymphatic system, allowing tailored interventions. These modalities are also available at Semmelweis University. Speaking about the development of lymphatic microsurgery, he highlighted lymphovenous bypass and vascularized lymph node transfer as options for the treatment of early and late-stage lymphedema, respectively. For patients who do not respond to conventional treatment and for whom microsurgery is not an option either, he suggested tissue reduction techniques such as liposuction.
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Presentations at the symposium provided an insight into the latest advances in lymphedema diagnosis, treatment, and research. Among the international presentations, Dr. Joon Pio Hong, Professor at the Asan Medical Center (University of Ulsan College of Medicine), Seoul, spoke about innovations in lymphatic surgery, while Dr. Manuel Cornely, Scientific Director of the not-for-profit limited liability company LY. SEARCH gGmbH, Germany, presented therapeutic options in surgical lymphology (lymphoedema, lipoedema). Dr. Chieh-Han John Tzou, Head of Plastic and Reconstructive Surgery at the Göttlicher Heiland Krankenhaus (Hospital of Divine Saviour) in Vienna and Associate Professor at Sigmund Freud University, analyzed the decision-making process in lymphatic surgery.
In the Hungarian section, Dr. Erzsébet Boros, Chief Physician at the Department of Rehabilitation Medicine of Semmelweis University, presented the complex rehabilitation of patients with lymphedema, while Dr. Marianna Rédling, Head of Lymphology at the South-Pest Hospital Centre, National Institute for Infectology and Haematology, spoke about new directions in the treatment of primary lymphedema. Dr. Győző Szolnoky, Chief Physician at the Department of Dermatology and Allergology of the University of Szeged, discussed the effectiveness of manual lymphatic drainage, while Dr. Zoltán Jakus, Associate Professor at the Department of Physiology of Semmelweis University, described the organ-specific functions of the lymphatic system. Dr. Balázs Mohos, the chief organizer of the symposium, gave an overview of the introduction of reconstructive lymphatic surgery in Hungary.
Dr. Balázs Mohos, specialist at the Városmajor Heart and Vascular Center, former employee of the Göttlicher Heiland Krankenhaus in Vienna, told our website that the center had been running the Reconstructive Lymphatic Surgery Profile since 2022, where the most modern technical equipment was used to perform routine, 5-6-hour reconstructive lymphatic surgery every week, which – even in Europe – was only available in a few major centers. He added that surgical intervention could only be offered to patients in conjunction with appropriate conservative therapy (compression therapy, mobilization). In order to treat lymphedema effectively and better understand the pathography, a human biobank – which is a rarity worldwide – was established at the Department of Physiology of Semmelweis University in collaboration with Associate Professor Dr. Zoltán Jakus. In this unique biobank, valuable tissue samples for basic research are collected and stored anonymously, offering a unique opportunity to study lymphatic diseases in more depth. The program has recently been joined by a working group from the Göttlicher Heiland Krankenhaus in Vienna, within the framework of which samples and the results of online data collection are shared.
Dr. Balázs Csizmadia / Róbert Tasnádi
Translation: Dr. Balázs Csizmadia
Photos by Bálint Barta – Semmelweis University
