MP89-02 EFFICACY OF INDOCYANINE GREEN FLUORESCENCE ANGIOGRAPHY FOR ARTERIAL SPARING DURING MICROSURGICAL SUBINGUINAL VARICOCELECTOMY

Abstract

You have accessJournal of UrologyInfertility: Therapy I1 Apr 2017MP89-02 EFFICACY OF INDOCYANINE GREEN FLUORESCENCE ANGIOGRAPHY FOR ARTERIAL SPARING DURING MICROSURGICAL SUBINGUINAL VARICOCELECTOMY Yasuhiro Shibata, Sota Kurihara, Seiji Arai, Takeshi Miyao, Yoshiyuki Miyazawa, Yoshitaka Sekine, Hidekazu Koike, Kazuto Ito, Tetsuya Nakamura, and Kazuhiro Suzuki Yasuhiro ShibataYasuhiro Shibata More articles by this author , Sota KuriharaSota Kurihara More articles by this author , Seiji AraiSeiji Arai More articles by this author , Takeshi MiyaoTakeshi Miyao More articles by this author , Yoshiyuki MiyazawaYoshiyuki Miyazawa More articles by this author , Yoshitaka SekineYoshitaka Sekine More articles by this author , Hidekazu KoikeHidekazu Koike More articles by this author , Kazuto ItoKazuto Ito More articles by this author , Tetsuya NakamuraTetsuya Nakamura More articles by this author , and Kazuhiro SuzukiKazuhiro Suzuki More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2017.02.2800AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Varicoceles are present in 20 to 30% of men with infertility; moreover, up to 10% of men with varicoceles experience scrotal pain. Varicocelectomy improves testicular function and may prevent the accelerated decline in sperm parameters and testosterone levels observed in men with varicoceles. Many studies have indicated that microsurgical subinguinal varicocelectomy is one of the best treatment modalities for varicoceles with regard to spontaneous pregnancy outcomes and complication rates; however, the difficulty in identifying testicular arteries that should be spared is a limitation of this technique. We previously reported the usefulness of intraoperative indocyanine green angiography (ICGA) to detect the thin arteries. In the present study, we assessed the feasibility of ICGA during microsurgical subinguinal varicocelectomy in comparison with standard procedures. METHODS Microsurgical subinguinal varicocelectomy using ICGA was performed in 48 patients with infertility or chronic pain associated with varicoceles. After exposure of the spermatic cord blood vessels, ICG was injected intravenously to identify and isolate the testicular artery. Intraoperative Doppler blood flow meter was also performed in 29 cases to compare both procedures for detection of the artery. Thereafter, the varicose veins were repeatedly ligated, while preserving a few lymphatic vessels and the spermatic duct. Seventy-eight cases without ICGA use were included as the control group, to determine the efficacy of the ICGA procedure. RESULTS The testicular artery was clearly identified by ICGA. The average operation time significantly decreased from 81.8 to 66.2 minutes with the use of ICGA. The number of preserved arteries was significantly increased by ICGA from 1.16 to 1.77. In 15 ICGA cases, very thin arteries that were undetectable with normal light view or Doppler study could be preserved. CONCLUSIONS Microsurgical subinguinal varicocelectomy using intraoperative ICGA enabled a faster procedure and secure preservation of testicular arteries. We believe that this is a significant surgical procedure for the treatment of varicoceles, especially for infertility patients in whom preservation of maximal blood supply is desired. © 2017FiguresReferencesRelatedDetails Volume 197Issue 4SApril 2017Page: e1202-e1203 Advertisement Copyright & Permissions© 2017MetricsAuthor Information Yasuhiro Shibata More articles by this author Sota Kurihara More articles by this author Seiji Arai More articles by this author Takeshi Miyao More articles by this author Yoshiyuki Miyazawa More articles by this author Yoshitaka Sekine More articles by this author Hidekazu Koike More articles by this author Kazuto Ito More articles by this author Tetsuya Nakamura More articles by this author Kazuhiro Suzuki More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...