Indigo Carmine Dye-Assisted Lymphatic-Sparing Laparoscopic Palomo Varicocelectomy In Children

Abstract

: The ideal method for varicocelectomy in children remains controversial. We present our experience with dye-assisted lymphatic-sparing laparoscopic varicocelectomy (LSLV) in children, which overcomes the limitations of previously described techniques. Materials and methods : Five consecutive LSLVs were performed over a period of three years on children with a mean age of twelve years. The varicocele grade was three in one case and grade 2 in four cases, respectively. A left subdartos injection of 2 ml of Indigo carmine dye was done using a 25-gauge needle at ten minutes before an operation. A scrotal injection of lymphatic dye was utilized to spare at least one lymphatic and the remaining spermatic vessels were divided. Results : Lymphatic-sparing was accomplished in all cases. No peri-operative complication was noted. We spared one lymphatic channel in one patient (20% %) and two channels in four patients (80% %). There were no cases of hydrocele or residual varicocele. Conclusion : Dye-assisted LSLV is easily accomplished with an excellent surgical outcome and sparing one or two lymphatics appears to be sufficient to avoid secondary hydrocele. J. Med. Invest. 61 : 151-155, February, 2014

Controversies in the Laparoscopic Treatment of Varicocele in the Pediatric Population

“…The procedure is facilitated by the magnifying effect of the laparoscopic lens, which allows for excellent visualization of the structures of the vascular bundle. To achieve better visualization of the lymphatics, recent findings have shown that intra-dartos/intra-testicular injection of isosulfan blue is significantly better than the previously described intra-dartos injection, thereby allowing identification of lymphatic vessels in 100% of the cases in our series [43][44][45][46].…”

Surgical approaches for varicocele in pediatric patient

“…Methylene blue was avoided because this dye may cause local tissue reactions. Ishibashi et al (23) used Indigo carmine because there has been extensive experience with this dye in cases of lymphatic mapping and sentinel node identification in cases of breast cancer. If 1-2 lymphatic channels were preserved during a varicocelectomy, there were no postoperative hydroceles.…”

The evolution and refinements of varicocele surgery

“…Ishibashi et al . 82 used Indigo carmine because there has been extensive experience with this dye in cases of lymphatic mapping and sentinel node identification in cases of breast cancer. If 1–2 lymphatic channels were preserved during a varicocelectomy, there were no postoperative hydroceles.…”