A novel anatomical approach to central lymphatics: cadaveric validation of abdominal and thoracic access for lymphovenous anastomosis

Central conducting lymphatic anomalies (CCLA) are rare disorders of the central lymphatic system. Lymphovenous anastomosis (LVA) is a promising option, but no standardized surgical access exists. We aimed to develop and validate a reproducible approach to the thoracic duct near its origin. Eight cadaveric specimens were studied using a two-phase protocol: development (n=6) and independent validation by surgeons unfamiliar with the technique (n=2). Feasibility of thoracic duct exposure and performance of LVA were assessed. The thoracic duct was consistently identified using abdominal and thoracic approaches. The azygos vein was the optimal recipient vessel; median thoracic duct–azygos distances were 4 mm (abdominal) and 3.5 mm (thoracic). Nine manual LVAs were successfully completed. Both approaches were reproduced by independent surgeons. Central LVA between the thoracic duct and azygos vein is anatomically and technically feasible via abdominal or thoracic access. These data support further preclinical studies evaluating functional outcomes before clinical translation.