Two decades of experience with laparoscopic varicocele repair in children: Standardizing the technique

Esposito, Ciro; Escolino, Maria; Castagnetti, Marco; Cerulo, Mariapina; Settimi, Alessandro; Cortese, Giuseppe; Turrà, Francesco; Iannazzone, Marta; Izzo, Serena; Servillo, Giuseppe

doi:10.1016/j.jpurol.2017.06.017

Cited by 25 publications

(17 citation statements)

References 40 publications

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“…Testicular artery ligation in group A and testicular artery preservation in group B were done with a significant difference in varicocele persistence that was present in 1.25%, 10% in group A and group B respectively. These results are similar to that of Schwentner [14], Rizkala [15], Feber [17], and Esposito [24] in consideration to high varicocele persistence with artery preservation more than with artery ligation.…”

Section: Discussionsupporting

confidence: 88%

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Lymphatic sparing laparoscopic varicocelectomy with or without testicular artery preservation: is there a difference?

et al. 2020

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Section: Discussionsupporting

confidence: 88%

“…Esposito C et al believed that the standard treatment for varicocele in pediatrics is the lymphatic sparing laparoscopic Palomo varicocelectomy using preoperative intra-dartoic isosulfan blue injection as it is technically easy and fast with no more than 1% recurrence rate [24].…”

Section: Discussionmentioning

confidence: 99%

Lymphatic sparing laparoscopic varicocelectomy with or without testicular artery preservation: is there a difference?

et al. 2020

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“…Before the advent of ICG-enhanced fluorescence, we already performed lymphatic-sparing varicocele repair using intradartoic/ intratesticular injection of isosulfan blue dye. As we already published, we recorded no postoperative hydrocele also using this last technique (28). Thereafter, we decided to adopt ICG to perform lymphography and we standardized the injection technique (18).…”

Section: Discussionmentioning

confidence: 82%

Image-Guided Pediatric Surgery Using Indocyanine Green (ICG) Fluorescence in Laparoscopic and Robotic Surgery

et al. 2020

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Background: Indocyanine green (ICG)-guided near-infrared fluorescence (NIRF) has been recently adopted in pediatric minimally invasive surgery (MIS). This study aimed to report our experience with ICG-guided NIRF in pediatric laparoscopy and robotics and evaluate its usefulness and technique of application in different pediatric pathologies.Methods: ICG technology was adopted in 76 laparoscopic and/or robotic procedures accomplished in a single division of pediatric surgery over a 24-month period (January 2018-2020): 40 (37 laparoscopic, three robotic) left varicocelectomies with intra-operative lymphography; 13 (10 laparoscopic, three robotic) renal procedures: seven partial nephrectomies, three nephrectomies, and three renal cyst deroofings; 12 laparoscopic cholecystectomies; five robotic tumor excisions; three laparoscopic abdominal lymphoma excisions; three thoracoscopic procedures: two lobectomies and one lymph node biopsy for suspected lymphoma. The ICG solution was administered into a peripheral vein in all indications except for varicocele and lymphoma in which it was, respectively, injected into the testis body or the target organ. Regarding the timing of the administration, the ICG solution was administered intra-operatively in all indications except for cholecystectomy in which the ICG injection was performed 15-18 h before surgery. Results:No conversions to open or laparoscopy occurred. No adverse and allergic reactions to ICG or other postoperative complications were reported.Conclusions: Based upon our 2 year experience, we believe that ICG-guided NIRF is a very useful tool in pediatric MIS to perform a true imaged-guided surgery, allowing an easier identification of anatomic structures and an easier surgical performance in difficult cases. The most common applications in pediatric surgery include varicocele repair, difficult cholecystectomy, partial nephrectomy, lymphoma, and tumors excision but further indications will be soon discovered. ICG-enhanced fluorescence was technically Esposito et al.ICG-Guided NIRF in Pediatric MIS easy to apply and safe for the patient reporting no adverse reactions to the product. The main limitation is represented by the specific equipment needed to apply ICG-guided NIRF in laparoscopic procedures, that is not available in all centers whereas the ICG system Firefly ® is already integrated into the robotic platform.

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“…La alternativa de evitar la reparación quirúrgica del varicocele y esperar hasta que se presente un problema de infertilidad no parece ser la mejor opción para estos pacientes. Por esta razón, se acepta ampliamente la indicación de un tratamiento precoz en la infancia y adolescencia para prevenir el daño testicular (20,21) .…”

Section: Discussionunclassified

Quince años de experiencia en el tratamiento laparoscópico del varicocele pediátrico con un solo puerto de trabajo y tecnología Ligasure

Méndez-Gallart¹,

García-Palacios²,

Rodríguez-Barca³

et al. 2023

Cir Pediatr

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ResumenIntroducción. El varicocele es una dilatación anormal de las venas espermáticas internas del cordón espermático. Su prevalencia se estima en 15% de varones adultos jóvenes. Aunque la mayoría son asintomáticos, en niños y adolescentes el dolor escrotal y la hipotrofia testicular son frecuentes. Existe controversia sobre las indicaciones y el abordaje óptimo para su tratamiento. Presentamos los resultados de nuestra serie de 15 años en la reparación laparoscópica del varicocele pediátrico.Material y métodos. Revisamos 238 pacientes diagnosticados de varicocele y sometidos a corrección laparoscópica desde 2006 hasta 2020. Las variables registradas fueron: edad, síntomas, grado, atrofia testicular, duración de la estancia, complicaciones perioperatorias, recidivas y formación de hidrocele reactivo. El seguimiento medio fue 5,6 años (6 meses-9 años).Resultados. La edad promedio fue 14,1 años. 188 pacientes presentaban varicocele grado III. En 14 casos el varicocele era bilateral. Se observó atrofia testicular en 42% al diagnóstico, de los que el 74% eran mayores de 15 años. Cincuenta y un pacientes refirieron dolor testicular. Todos los pacientes se sometieron al tratamiento laparoscópico. El tiempo operatorio promedio fue 36 min. La mediana de estancia fue 31 horas. La tasa de recidiva fue 2,1%. Cuarenta y tres pacientes desarrollaron hidrocele (18%); pero solo 27 precisaron hidrocelectomía según plicatura de Lord al menos un año poslaparoscopia (11,2%). De los 16 restantes, dos se resolvieron espontáneamente y 14 se mantuvieron estables en el seguimiento medio de siete años. En 7,1% se notificaron parestesias en la cara anterointerna del muslo izquierdo.Conclusión. Basándonos en nuestra serie, creemos que la laparoscopia debe considerarse el gold standard en edad pediátrica. La varicocelectomía laparoscópica es técnicamente fácil y rápida, indolora y con una tasa de recurrencia del 1%. Los procedimientos de preservación de los linfáticos podrían reducir al mínimo las tasas de hidrocele reactivo como complicación a largo plazo.

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Two decades of experience with laparoscopic varicocele repair in children: Standardizing the technique

Cited by 25 publications

References 40 publications

Lymphatic sparing laparoscopic varicocelectomy with or without testicular artery preservation: is there a difference?

Lymphatic sparing laparoscopic varicocelectomy with or without testicular artery preservation: is there a difference?

Image-Guided Pediatric Surgery Using Indocyanine Green (ICG) Fluorescence in Laparoscopic and Robotic Surgery

Quince años de experiencia en el tratamiento laparoscópico del varicocele pediátrico con un solo puerto de trabajo y tecnología Ligasure

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