Identifiying the ideal point of injection in ICG-assisted lymphatic-sparing Palomo procedure: A case report

We report a 13-year-old boy with varicocele, testicular hypotrophy, and recurrent torsion-detorsion episodes who underwent combined ICG-assisted lymphatic-sparing laparoscopic Palomo varicocelectomy and bilateral orchidopexy. Three ICG injection sites were tested: (1) transcutaneous near the dartos of the spermatic bundle, (2) directly inside the dartos, and (3) beneath the parietal vaginalis tunica. Only (3) successfully identified lymphatic vessels adjacent to the spermatic vessels. The surgery was uneventful, and at 2 months postoperatively, pain resolved and varicocele improved clinically and sonographically. Injecting ICG into the parietal vaginalis tunica optimizes lymphatic visualization and may help standardize para-testicular ICG administration.