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

Abstract

We reported our initial experience of robotic‐assisted laparoscopic artery‐sparing varicocelectomy using indocyanine green (ICG) fluorescence angiography in treatment of varicocele. A total of 45 varicocelectomies in 27 patients were performed. The mean operation time was 49.1 ± 8.5 min for unilateral and 65.6 ± 8.3 min for bilateral repair. 47.2 s after ICG injection, testicular artery (TA) was visualised. After an interval of 31.3 s, fluorescent veins were identified. Of all the 45 spermatic cords, 68.9% had a solitary artery, while 31.1% had 2 arteries. The mean hospital stay was 1.6 ± 0.9 days. Semen concentration and motility were significantly improved 6 months after surgery, no recurrence, hydrocele or testicular atrophy was observed. Our study demonstrated that robotic‐assisted laparoscopic artery‐sparing varicocelectomy using ICG fluorescence angiography is a safe, effective and promising technique in treatment of varicocele.

The Effect of Subcutaneous and Intraperitoneal Instillation of Local Anesthetics on Postoperative Pain after Laparoscopic Varicocelectomy: A Randomized Controlled Trial

“…A varicocele represents an abnormal enlargement of the veins within the pampiniform plexus and has been recognized as one of the most frequent causes of infertility in men, with an incidence in the pediatric population of 10-15% [1]. Around 40% of adult males with this abnormality are infertile [1][2][3]. The usual modality of treatment, with a very high success rate, is surgical varicocelectomy.…”

“…The usual modality of treatment, with a very high success rate, is surgical varicocelectomy. Today, several surgical approaches for successful varicocele treatment are available, including open inguinal, subinguinal microscopic laparoscopic, and robotic-assisted laparoscopic ligation [1][2][3][4]. Due to the benefits of minimally invasive surgery, laparoscopic varicocelectomy has been popularized and has gained growing acceptance among pediatric surgeons [4].…”

The Management of Clinical Varicocele: Robotic Surgery Approach

“…The da Vinci surgical system is the only commercially available robotic platform, widely used for several types of surgical procedures ( 38 ). Recently some studies showed robotic use in microsurgical procedures for male infertility included varicocele treatment ( 39 , 40 ). Subinguinal microscopic varicocelectomy showed superior outcomes compared with other techniques ( 41 ).…”

“…Robotic varicocelectomy shows several limitations: first, the cost of robotic surgery is much higher than other approaches. Second, external spermatic perforators/gubernacular veins could not be handled under a robotic laparoscopic approach ( 39 , 50 ).…”

Indocyanine green guided near-infrared fluorescence (ICG-NIRF) enhances vascular anatomy in robotic assisted DIEP flap harvest

“…ear-infrared fluorescence (NIRF) imaging technology using indocyanine green (ICG) as the fluorescent agent has been shown to be beneficial in numerous robotic procedures. [1][2][3][4][5][6][7] The current generation of robots, such as da Vinci Xi (Intuitive Surgical, Sunnyvale, CA), is equipped with a software for NIRF detection, named FireflyR (Novadaq Technologies, Mississauga, Ontario, Canada), directly controlled by the console surgeon. 1 The vascular anatomy can be visualized within seconds after the intravenous injection of ICG.…”