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In some patients with lymphedema, it is important to create asmany lymphaticovenular anastomoses (LVAs) as possible.1 In such cases, LVAs are usually performed simultaneously at multiple sites and require use of at least two operating microscopes.2 A drawback of this method is that it requires more than two expertmicrosurgeons, each equippedwith an operating microscope, which is beyond the resources of many hospitals. This problem can be overcome by implementing a line production system (LPS) whereby multiple LVAs can be performed using loupes for dissection of lymphatics and veins.3 Dissection of lymphatics under loupes is feasible for a novice surgeon; however, it is necessary to master some “tricks of the trade” to be able to find and dissect lymphatics under loupes efficiently. The aim of this paper was to describe in detail how to dissect lymphatics accurately under loupes.

How to Dissect Lymphatics under Loupes for Line Production System for Multiple Lymphaticovenular Anastomosis