At that point, we observed dilated lymphatic vessels that seemed to have a good lymphatic function intraoperatively. However, when we dissected the lymphatic vessel proximally, we found that it was suddenly shrunken (Fig 3). Although we waited for a while, considering the possibility of lymphatic spasm, it remained in the same condition. We concluded that this suddenly shrunken part of the lymphatic vessel was a cause of ICG disruption and lymphatic flow was blocked at this point; hence, we decided to perform LVA at the distal part of this lymphatic vessel. We also performed 4 additional LVAs using 2 surgical microscopes with 2 surgeons (H.H. and M.M.). The conditions of the other lymphatic vessels were as follows: normal type for 1 lymphatic vessel; ectasis type for 2; contraction type for 1; and sclerosis type for 1. The operation time was 2 hours 10 minutes, and the amount of bleeding was minimal.