Scripps physician scores surgical first in region

When Encinitas resident Dr. Manish Champaneria performed a vascular lymph node transfer on a breast cancer survivor Oct. 4, it was the first such procedure to be performed in the region, Scripps Health officials say.

The patient, Margaret Petersen, couldn’t be happier, as she experienced the benefit of reduced discomfort within days.

“I think it’s kind of exciting really,” the Poway resident said. “Dr. Champaneria had done it previously, but not here. He asked me if I was willing to be the first one. ... He described the benefits going forward. I had no hesitation.”

Champaneria, 40, trained for microsurgery at the University of Washington. He said he had done the lymphedema operation more than 40 times during his plastic surgery practice in southwest Washington state.

Yet, prior to the October surgery, he had not tackled one in this area since taking a job with Scripps MD Anderson Cancer Center earlier this year.

Champaneria, who grew up in Southern California, sought the position at least in part to be closer to his family.

“Lymph node transfers are rarely performed in the U.S.,” he said. “It is slowly becoming more common, but only at major academic centers and only where there are practitioners trained in this type of microsurgery.

“Microsurgery is the utilization of a microscope to perform a surgery where we transplant tissues from one body part to another body part of need. We’re suturing vessels together — arteries and veins. Sometimes, we also suture nerves together. The scope of the surgery is small, requiring the use of a microscope.”

Lymphedema consists of a chronic, debilitating swelling of the upper or lower extremities as a result of a lymphatic obstruction, Champaneria said. The lymphatic system is a network of tissues and organs through which lymph fluid flows to help rid the body of toxins and other unwanted substances.

In the U.S., Champaneria said, lymphedema most commonly is a complication of surgery, including mastectomies, and typically results in swelling and discomfort in the affected limb. There also is a risk of infection and the danger of breast cancer spreading to lymph nodes.

Dr. Manish Champaneria performs the first vascular lymph node transfer microsurgery Oct. 4 at Scripps Green Hospital in Torrey Pines

(Courtesy of Scripps Health)

Traditionally, lymphedema has been treated with physical therapy, compression garments and manual draining. Yet, these techniques can be ineffective, as in Petersen’s case.

The microsurgery eliminates the root cause of lymphedema by removing healthy lymph nodes along with connecting blood vessels and tissue. They are then relocated to the part of the body where the lymphatic system is blocked, so lymph fluid can once again flow through the affected area.

“This is one esoteric, unique aspect of microsurgery,” Champaneria said. “There is a great need. A lot of patients don’t know how to treat lymphedema and how to take care of it, and a lot of physicians don’t either. So there’s a great need and pretty good outcomes.”

Often, he said, it can take many months for a patient to experience the benefits of the microsurgery. He started seeing improvement in Petersen shortly after the operation, which occurred at Scripps Green Hospital in Torrey Pines.

Petersen estimated the operation took about six hours. She spent the night at the hospital and was released the next day.

“The patient is recovering well,” Champaneria said. “She already reports that she has reduced swelling in her arm. Her sleeves are fitting her better.

“The results can vary from patient to patient. Sometimes it can take one year to two years to see the results, but this patient has already exhibited improvement. So it’s a success all around.”

Petersen, a two-time survivor of breast cancer, said she didn’t realize that she was improving until her first visit with Champaneria following the operation.

“He said, ‘Did you notice anything?’ and I said, ‘No, I didn’t,’ and then I took a look and I said, ‘Yes, I do see something.’ Already my arm (was smaller) after two weeks. ... I’m not supposed to be pushing the envelope yet, but I don’t feel any discomfort in movement in any way, shape or form.”

The mother of seven now adult children, Petersen said much of her confidence in undergoing the operation stemmed from her comfort with Champaneria, who had performed reconstructive surgery on her following her mastectomy in February.

Champaneria, she said, warned her the lymphedema affecting her right arm could worsen and recommended the lymph node transfer procedure.

“I’d never heard of it before,” she said. “I was lucky to be in the right place at the right time. Dr. Champaneria presented a really good case for the benefits of it. But I had already been with him (through reconstructive surgery) so he had my upmost trust.”

Champaneria said he recommended the microsurgery to Petersen because she did not appear to be improving through other methods, including manual drainage.

He has scheduled other lymph node transfer operations in the coming months. The microsurgeries can take place at Scripps Green, Scripps Memorial Hospital La Lolla and potentially other Scripps centers.

“We’re just trying to increase exposure and get the word out that such procedures exist and there are options for lymphatic reconstruction,” he said.

He has an enthusiastic endorsement in the first person to experience a lymph node transfer in San Diego County.

Said Petersen: “I have a 17-month-old granddaughter, so one of the things I am looking forward to is to be able to be fully functional with her and being able to carry her around.”

Note: Champaneria is the San Diego Lymphedema Support Group Meeting featured speaker on Nov, 16. Champaneria will be presenting surgical options to treat lymphedema including lymph node transfer and lymphaticovernous bypass.

Lymphedema patients, caregivers and medical providers are welcome to attend the Nov. 16 event which will run from 2 p.m. to 3 p.m. at the Mission Valley Branch Library of the San Diego Public Library, 2123 Fenton Parkway, Seminar Room A, San Diego.

This patient-run support group meets on the third Saturday of each month and welcomes all lymphedema patients and caregivers to attend.

For more information regarding upcoming meeting topics, visit the group’s Facebook page: Lymphedema San Diego or e-mail SDLymphedema@gmail.com