Lymphatic sparing, laparoscopic varicocelectomy: a new surgical technique

Abstract

Several surgical options are available for managing varicoceles. Although conventional surgery offers good surgical results, the most common long-term complication of surgery is the development of hydroceles, thought to be due to interruption in the lymphatic outflow from the subservient testis. The authors describe a new technique of in vivo methylene blue mapping of testicular lymphatic vessels at laparoscopy, allowing these vessels to be spared during laparoscopic varicocelectomy. This novel method of in vivo staining of lymphatic vessels should prevent damage to the lymphatic system and avoid the late development of hydroceles. A prospective multicenter trial is currently underway to evaluate the medium- and long-term results.

Dye-Assisted Lymph Vessels Sparing Laparoscopic Varicocelectomy

“…No adverse local or generalized reactions or postoperative scrotal hematoma were found in any of the patients. At an average follow-up of 14 months (range, [6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21][22][23][24], no recurrent varicocele or testicular volume reduction were detected. Postoperative hydrocele was observed in 4 patients from NLS group (13.8%).…”

Treatment of varicocele with reference to age: a retrospective comparison of three minimally invasive procedures

“…In the initial series of 56 patients using this technique during an open Palomo procedure, no hydroceles were reported [17]. This technique can be combined with the laparoscopic approach, as demonstrated by several groups [2,20,24].…”

Lymphatic sparing laparoscopic Palomo varicocelectomy for varicoceles in children: intermediate results

“…One approach to augment visualization of the lymphatic vessels was described by Oswald et al, who injected isosulphan blue into the parietal fold of the tunica vaginalis during the open Palomo procedure and reported no postoperative hydroceles in their initial series of 56 patients [23]. This technique can be readily combined with the laparoscopic approach, as demonstrated by several groups [6,15]. In our study, we used isosulphan blue injection into the tunica vaginalis to stain the lymphatic vessels of the testes for their preservation during ligation of the artery and vein.…”

“…It is performed using Palomo's general concept of mass ligation of all the enlarged testicular vessels above the inguinal ring with lymphatic preservation [15]. Therefore, it shares similar features with the open Palomo technique.…”