Is There Any Role for Indocyanine Green Angiography in Testicular Artery Preservation During Microsurgical Subinguinal Varicocelectomy?

Abstract

Varicocelectomy is the most commonly performed surgery for the correction of male factor subfertility. Microsurgical subinguinal varicocelectomy (MSV) is generally considered the gold standard nowadays in view of the lower risk of complications and recurrence. To achieve complete ligation of veins while preserving testicular artery during the procedure remains challenging despite the application of high-power optical magnification and micro-Doppler ultrasonography. The application of indocyanine green (ICG) angiography with infrared fluorescence operative microscope in MSV potentially lowers the incidence of testicular arterial injury by providing high-contrast real-time images on vascular anatomy. Arteries of 1 mm diameter or less are demonstrated on angiographic images. Testicular, cremasteric, and deferential arteries are clearly visualized within 1 min upon ICG injection. The short half-life and low risk of adverse reaction of ICG allow repeated administration without compromising the quality of images. The administration of ICG is simple and quick. The interpretation of angiography is often straightforward. The clear angiographic images are particularly helpful for documentation and training purposes. Technical advances in intraoperative ICG angiography includes ICG dynamics and novel operating platforms. The innovations may prove their role in clinical application in the near future. In summary, the use of intraoperative ICG angiography facilitates early testicular artery visualization and may potentially decrease the incidence of testicular artery injury during varicocelectomy. The technique represents a valuable adjunct to the procedure of varicocelectomy and may shorten the learning curve of novice surgeons.