Indocyanine Green Fluorescence Lymphography for Lymphatic-Sparing Laparoscopic Palomo Varicocelectomy in Children: 5-Year Experience and Technical Considerations.

BACKGROUND

This study reports our 5-year experience in performing lymphography using indocyanine green (ICG)-enhanced fluorescence to perform lymphatic-sparing laparoscopic Palomo varicocelectomy.

PATIENTS AND

METHODS

The records of 103 patients who underwent laparoscopic left varicocelectomy from March 2018 to April 2023 were retrospectively evaluated. The average patients' age was 13.7 years (range: 12-16). High-degree varicocele was associated with left testicular hypotrophy, and symptoms were present in all patients. At the beginning of our experience, in 41 cases, we injected 2 mL of ICG solution into the testis, then we reduced the amount of ICG solution to 1 mL, having the same results. The lymphatic vessels were clearly identified and spared, then the entire spermatic bundle was clipped and divided according to Palomo's principle.

RESULTS

We reported no conversions to open surgery and no adverse reactions induced by ICG. The average operative time was 18 minutes (range: 10-35). We performed clinical evaluations at 1 week, 1 month, 6 months, 1 year, and 2 years after surgery, and Ultrasound (US) was performed at 1 and 2 years postoperatively. In 3 patients, we discovered a small calcification due to the injection of the dye inside the testis; for this reason, we reduced the amount of ICG from 2 to 1 mL with the disappearance of this problem. No recurrence of varicocele or postoperative hydrocele was recorded.

CONCLUSIONS

Our 5-year experience showed that the intratesticular injection of ICG and use of fluorescence vision allowed identification of lymphatic. ICG fluorescence lymphography is a safe and effective option to perform lymphatic-sparing laparoscopic Palomo varicocelectomy in children and adolescents with high-degree varicocele. No allergy to ICG or postoperative hydrocele was reported in our experience. It is preferable to inject 1 mL of ICG solution in the testis to avoid the risk of having small calcification in the testis at US controls.