Fig. 1

Operative steps for intralymphatic cannulation. a) Cut down over the femoral vessels. A vessel loop is used to encircle the femoral lymphatic vessel (white arrow) and after sharp sharp incision of the lymphatic vessel, the cannula is threaded (black arrow) using an operative microscope b) View through operative microscope of the cannula entering intralymphatic vessel (dark arrow) c) Intralymphatic port (connected to a lymphatic vessel) prior to its implantation in the subcutaneous pocket d) Lymphangiogram demonstrating patency of a subcutaneous intralymphatic port. Contrast material (2 cc) is seen flowing into the right femoral lymphatic vessel via a subcutaneous port and accumulating in multiple inguinal lymph nodes