Preliminary experience with indocyanine green lymphography during microsurgical subinguinal varicocelectomy

Abstract

Objective: The aim of the present study was to evaluate the feasibility to expand the use of indocyanine green (ICG) to lymphatic-sparing microsurgical subinguinal varicocelectomy (MSV) in addition to ICG angiogram by using video microsurgery platform.Patients and Methods: Seven patients with 12 varicoceles had MSV and intraoperative ICG lymphography performed from July 2019 to February 2020. Intraoperative ICG lymphography was employed to confirm and preserve lymphatics after intra-parenchymal testicular injection of ICG.Results: Lymphatic vessels were clearly identified on ICG lymphography in all varicocele units with intra-parenchymal testicular injection. ICG lymphography did not significantly interfere with the quality of subsequent ICG angiography in the majority of patients. All patients were discharged uneventfully within 24 h after the operation.No complications were reported with a median follow up duration of 9 months. Conclusions:The use of intraoperative ICG lymphography consistently provides objective assessment of lymphatic vessels during the procedure of MSV.

Indocyanine green angiography and lymphography in microsurgical subinguinal varicocelectomy with evolving video microsurgery and fluorescence imaging platforms

“…After preservation of the testicular arteries, the differentiation between lymphatics and small veins was facilitated by ICG lymphography performed following intraparenchymal testicular injection of 0.5 mL (1.25 mg) ICG solution followed by gentle testicular massage. 3…”