Use of indocyanine green angiography in microsurgical subinguinal varicocelectomy - lessons learned from our initial experience

Abstract

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 (TA) during the procedure remains challenging despite the application of high power optical magnification and micro-Doppler ultrasonography. The use of intraoperative indocyanine green angiography (ICGA) with infrared fluorescence operative micro-scope in MSV potentially lowers the incidence of TA injury and shortens the learning curve of novice surgeons. We present our initial experience in the application of the technique in nine patients and explore the potential of the new adjunct.

Robotic‐assisted laparoscopic artery‐sparing varicocelectomy using indocyanine green fluorescence angiography: Initial experience

“…Recent years, ICG has gained myriad clinical applications; however, the use of ICG in varicocelectomy was seldomly reported. Currently, only 4 studies evaluated the efficacy of ICG in artery-or lymphatic-preserving varicocelectomy; none of them were under a robotic system (Cho, Ho, Chan, Chu, & Law, 2017;Esposito et al, 2019;Shibata et al, 2017;Tomita et al, 2017).…”

Use of video microsurgery platform in microsurgical subinguinal varicocelectomy with indocyanine green angiography

“…The use of ICGA can be easily incorporated into the intraoperative setting, and has been applied in various specialties where the status of blood circulation is of particular concern . The clear angiographic pictures provided by ICGA facilitate better preservation of the testicular artery during MSV, and its potential value was recently reported . The adoption of ICGA in MSV is made possible by the availability of the infrared fluorescence imaging function in operating microscopes.…”

“…The adjunctive use of micro‐Doppler represents the most widely‐adopted technique for arterial identification and preservation during MSV at present . More recently, further refinement of arterial preservation with the application of intraoperative indocyanine green angiography (ICGA) has demonstrated its great potential in testicular artery identification during MSV …”

Improved Arterial Preservation achieved by Combined Use of Indocyanine Green Angiography and Doppler Detector during Microsurgical Subinguinal Varicocelectomy

“…More recently, the application of indocyanine green angiography (ICGA) has been reported in the literature [4]. ICGA has demonstrated its capability in provision of objective assessment of testicular artery, and the technique is potentially superior to and provides additional information compared to the current armamentarium [5]. In this issue of the Journal of Investigative Surgery, Dr Kuihara, from Japan, produced an elegant manuscript that presents their experience in testicular artery preservation during MSV by utilizing different adjunctive measures [6].…”