A technique for laparoscopic varicocelectomy in children with ICG fluorescent lymphography

Abstract

Introduction. Laparoscopic varicocelectomy by the Palomo-Erokhin technique is one of the most common approaches for treating varicocele in children, but postoperative hydrocele is still a major complication after it. The authors present a novel technique of lymphography with indocyanine green (ICG). Material and methods. A case of a boy, aged 13, with grade 3 varicocele accompanied by hypotrophy of the left testicle and pain in the left half of the scrotum is described in the article. He was operated on laparoscopically by the Palomo–Erokhin technique using RUBINA manufactured by Karl Storz company. After placing trocars under the tunica albicans of the left testicle, 6.5 mg ICG fluorescent solution was injected. Lymphatic vessels were clearly identified on ICG images. The testicular vein was separated from the vascular bundle, then ligated and transected. Results. Intratesticular ICG injection and fluorescent images allowed to identify all lymphatic vessels. Surgery lasted for 25 minutes. No allergies or other adverse reactions caused by ICG were registered. In 6 months, there were no signs of recurrence and hydrocele formation. Conclusion. Our initial experience has shown that fluorescent lymphography with ICG is a safe and effective technique for lymph-sparing laparoscopic varicocelectomy in children, when using the Palomo-Erokhin technique.