Two-Port Laparoscopic Palomo Varicocelectomy with Indocyanine Green-Assisted Lymphatic Preservation: A Technical Note

Selective preservation of the testicular lymphatics is the most effective among the strategies for preventing postoperative hydrocele after laparoscopic Palomo varicocelectomy (LPV). Classical methods employ intraoperative dyes, such as isosulfan blue, instead of indocyanine green (ICG), which enables clearer and real-time lymphatic mapping through near-infrared imaging after intratesticular injection. ICG facilitates the precise identification and preservation of lymphatic vessels and reduces hydrocele risk. Notably, LPV is traditionally performed with three trocars, but this technical note describes a two-port ICG-assisted modification based on an illustrative case and discusses its practical implications, highlighting its potential as a tool for advancing single-incision laparoscopic surgery.