Tips and tricks in the setup of the surgical management of massive localized thigh lymphedema

Massive localized thigh lymphedema (MLL) is a rare, debilitating consequence of lymphedema, particularly prevalent in morbidly obese individuals. Its clinical presentation, often mimicking liposarcoma, poses diagnostic challenges. Surgical resection remains the primary treatment, accompanied by weight management counseling to prevent recurrence. This paper presents a detailed novel method of patient positioning in MLL resection. The authors describe the use of dual support candy cane stirrups, towel clamps, LigaSure TM , and a unique direct smoke evacuator to optimize access to the posterior medial thigh and the MLL. This paper also highlights the importance of recognition, dissection, and ligation of limb pedicle to prevent recurrence. The novel positioning technique facilitates efficient and complete resection of the MLL mass without complications due to better accessibility and support. The surgery for MLL resection can be challenging, thus we provide tips on a better method of patient setup for clearer accessibility to the field and a more streamlined method for patient and staff safety as well as surgeon ergonomics during the prolonged surgery. This paper underscores the importance of accurate MLL diagnosis and emphasizes the efficacy of surgical treatment. It introduces innovative patient positioning strategies to enhance MLL resection effectiveness and minimize surgical burden. As MLL prevalence rises with global obesity, healthcare professionals must be equipped with both diagnostic expertise and practical surgical techniques to address this challenging condition.