Lymphatic preservation using methylene blue dye during laparoscopic varicocelectomy: early results

Hydrocele caused by the division of lymphatic vessels during varicocelectomy is a common complication. Preservation of these lymphatics is the aim of many studies. We evaluated patient outcomes after laparoscopic varicocelectomy that involved intratunical methylene blue dye injection just prior to the procedure.

This prospective study included all adult patients (over age 14 years) with clinically palpable varicocele who presented to our clinic between December 2005 and July 2007. Prior to laparoscopic surgery, methylene blue dye was injected in the intratunical space between the tunica albuginea and the tunica vaginalis. Laparoscopic intraperitoneal varicocele ligation was performed. Patients were assessed for early postoperative complications and consumption of analgesia. They were reassessed at 1 and 6 months postoperatively by clinical and radiological evaluations to detect hydrocele formation, recurrent varicocele, and testicular pain or atrophy.

Twenty-three consecutive patients with 40 clinically palpable varicoceles were evaluated. The patients had a mean age of 28.4 years. The mean operating time was 37 minutes, (range, 25 to 50 minutes). The patients did not have any intraoperative or early postoperative complications, including any complications related to methylene blue dye injection. Follow up examinations at 6 months revealed hydrocele formation in 2 of the 40 patients (5%) and recurrent varicocele in 1 of the 40 patients (2.5%).

This preliminary study suggests that intratunical injection of methylene blue dye just prior to laparoscopic ligation of varicocele can aid in the identification and sparing of lymphatic vessels, although it did not preserve lymphatic vessels in all patients in this study. It appears to be a safe technique that does not prolong operating time.