Dr. Mark L. Smith and his colleague Dr. Joseph Dayan operating  together on a lymph node transfer.

Dr. Mark L. Smith and his colleague Dr. Joseph Dayan operating  together on a lymph node transfer.

Dr. Smith

As a specialist in microsurgical cancer reconstruction, I frequently encountered patients with lymphedema who were frustrated by the progressive and often disabling nature of this condition.  While successful treatment of lymphedema using vascularized lymph node transfer had been reported, there was a lack of rigorous scientific study in this field.  The main questions that concerned surgeons and patients were: Does it work?  How does it work? ...and is it safe?  

Early on, I began looking at scientific ways to answer these questions in order to maximize the safety and success of this procedure.  My colleagues and I re-evaluated the anatomy and physiology of the lymphatic system using the latest imaging technology.  We mapped the location of nearly 2000 groin lymph nodes using magnetic resonance angiography (MRA) to define surgical  landmarks to guide the harvest of lymph nodes draining the lower abdomen while avoiding those that drain the lower extremity.  This work was recently published in the Journal of Reconstructive Microsurgery.  While this study provided general guidelines for harvest, there are variations in lymphatic anatomy between patients.  

 

Drs. Mark L. Smith and Joseph Dayan demonstrating Reverse Lymphatic Mapping at the International Symposium on the Surgical Treatment of Lymphedema.

Drs. Mark L. Smith and Joseph Dayan demonstrating Reverse Lymphatic Mapping at the International Symposium on the Surgical Treatment of Lymphedema.

In order to further improve the safety of the procedure, we developed a technique called Reverse Lymphatic Mapping (RLM) that allows surgeons to precisely assess a patient's individual lymphatic drainage pattern during surgery.  For these contributions to the responsible practice of lymphatic surgery, I received a generous grant from the Gerald J. and Dorothy R. Friedman Foundation to create the Center for Lymphedema Research and Treatment.  The Center is dedicated to advancing the knowledge and surgical treatment of lymphedema.

 

 

Our Team

Physician assistant Pashmena Ahmadi.

Physician assistant Pashmena Ahmadi.

Our microsurgical team setting up for a lymph node transfer.

Our microsurgical team setting up for a lymph node transfer.

At Mount SInai Beth Israel, 150-200 microsurgical cases are performed each year. Led by physician assistant, Pashmena Ahmadi, our surgical team of operating room nurses, surgical technicians and anesthesiologists, have extensive experience in microsurgical procedures.  This ensures every aspect of the surgery from set-up to wake-up is seamless and efficient, allowing for a safe environment while minimizing the duration of general anesthesia.