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Combination of High Ligation and Intraoperative Embolization Using Polidocanol for Treatment of Varicoceles
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Dye-assisted lymph vessels sparing laparoscopic varicocelectomy.

Andrzej Golebiewski1, Marek Krolak, Leszek Komasara

  • 1Department of Pediatric Surgery and Urology, Medical University of Gdansk, Gdansk, Poland. angol@amg.gda.pl

Journal of Laparoendoscopic & Advanced Surgical Techniques. Part A
|June 16, 2007
PubMed
Summary

Patent blue V dye effectively identifies lymphatic vessels during laparoscopic varicocelectomy in adolescent boys. This lymphatic sparing technique significantly reduces the occurrence of postoperative hydrocele, improving surgical outcomes.

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Area of Science:

  • Urology
  • Surgical Innovation
  • Pediatric Surgery

Background:

  • Hydrocele is a common complication following laparoscopic varicocelectomy, often attributed to damage to gonadal lymphatic vessels.
  • Preserving lymphatic function is crucial to prevent postoperative hydrocele formation.

Purpose of the Study:

  • To evaluate the efficacy of patent blue V vital staining in identifying and preserving lymphatic vessels during laparoscopic varicocelectomy.
  • To assess whether a lymphatic sparing technique using patent blue V can prevent hydrocele development in adolescent boys.

Main Methods:

  • Fifty-two adolescent boys (12-16 years) with Grade III varicocele underwent left-sided laparoscopic varicocelectomy.
  • Patients were randomized into a lymphatic non-sparing (LNS) group (n=26) or a lymphatic sparing (LS) group (n=26).
  • In the LS group, patent blue V was injected to visualize lymphatic vessels before surgery.

Main Results:

  • Lymphatic vessels were identified in 88.5% of patients in the LS group.
  • No adverse reactions to patent blue V were observed.
  • Hydrocele developed in 4 patients (15.4%) in the LNS group, requiring surgery in one case.
  • No hydrocele developed in any patient (0%) in the LS group during a mean 14-month follow-up.

Conclusions:

  • Patent blue V vital staining is a simple and effective method for visualizing and preserving gonadal lymphatic vessels during laparoscopic varicocelectomy.
  • The lymphatic sparing technique significantly reduces the incidence of postoperative hydrocele in adolescent boys.
  • Larger studies and longer follow-up are needed to further validate these findings.