V11-05: Laparoendoscopic single-site (LESS) varicocelectomy using indocyanine green fluorescence (ICG) angiography
Varicocelectomy is the most commonly performed operation for the treatment of male infertility. Today, for this condition, the current standard surgical procedures are microscopic inguinal or subinguinal operations, laparoscopic retroperitoneal repair and sclerotherapy with the microsurgical technique is most popular approach of them. The treatment should be safe, minimally invasive and have a low rate of recurrence. Laparoscopic repair has higher recurrence rate than the microscopic technique with recurrences due to collaterals. On the other hand, Laparoscopic varicocelectomy should allow preservation of the testicular artery in a majority of cases, as well as preservation of lymphatics. We think that the persistent tiny vessels near the preserved arteries and lymphatics also cause recurrences. Therefore, to facilitate the identification of veins and to ensure the ligation, we performed Laparoendoscopic single-site (LESS) varicocelectomy using indocyanine green (ICG) fluorescence angiography.
A 2.5cm skin incision was made on the umbilicus with an approximately 3.5cm fascia incision. We used the OCTO PORT?, which had one 12mm port and two 5mm ports. After the exposure of the spermatic cord blood vessels, 1 ml of ICG (2.5mg/ml) was injected intravenously. The spermatic veins were sealed by ENSEAL? and cut. The spermatic artery and lymphatics were preserved. ICG was injected intravenously again in order to confirm that the arterial blood flow was preserved and that there was no remaining vein.
About 20seconds after injection of ICG, one spermatic artery could be clearly identified. And further about 20seconds after, 3 spermatic veins were identified. The artery could be preserved and the veins were sealed and cut. At this time, we performed ICG angiography again. The flow of the artery was adequately preserved and 1minute after the injection,venous flow was not observed. 3months after this operation, the varicocele had completely disappeared as was confirmed by color Doppler ultrasonography.
LESS varicocelectomy using ICG angiography facilitates identification of blood vessels and lymphatics by enabling the visualization of the spermatic cord blood arteries and vessels. We will continue to investigate whether this procedure will be considered a beneficial method.