Dye-assisted lymph vessels sparing laparoscopic varicocelectomy

• Published in: Journal of laparoendoscopic & advanced surgical techniques. Part A Vol. 17; no. 3; p. 360
• Main Authors: Golebiewski, Andrzej, Krolak, Marek, Komasara, Leszek, Czauderna, Piotr
• Format: Journal Article
• Language: English
• Published: United States 01-06-2007
• Subjects: Adolescent; Ambulatory Surgical Procedures; Child; Coloring Agents; Feasibility Studies; Follow-Up Studies; Humans; Laparoscopy - methods; Lymphatic Vessels - anatomy & histology; Male; Postoperative Complications - prevention & control; Rosaniline Dyes; Testicular Hydrocele - prevention & control; Testis - diagnostic imaging; Ultrasonography, Doppler; Varicocele - classification; Varicocele - surgery
• ISSN: 1092-6429
• DOI: 10.1089/lap.2006.0072

Hydrocele, the main complication of laparoscopic varicocelectomy, is thought to result from a disruption of gonadal lymphatics. The aim of this study was to evaluate the effectiveness of patent blue V dyeing to identify and preserve lymphatic vessels and to assess whether the lymphatic sparing technique avoids postoperative hydrocele in adolescent boys undergoing a laparoscopic procedure.
Fifty-two (52) boys affected by varicocele Grade III (range, 12-16 years) underwent a left-sided laparoscopic varicocelectomy. Twenty-six (26) boys were randomly assigned to a lymphatic nonsparing (LNS) group, and the others to a lymphatic sparing (LS) group. Before surgery in the LS group, 2 mL of patent blue V was injected under the tunica dartos on the left side.
All varicocelectomies were performed laparoscopically. Lymphatic vessels were identified in 23 (88.5%) boys of the LS group. In the remaining three (11.5%), the lymphatics could not be identified clearly. No adverse local or generalized reactions were noted. At a mean follow-up of 14 months, no recurrent varicocele or testicular volume reduction were detected. Hydrocele developed in 4 LNS patients and 1 was operated on. No patient from the LS group developed a hydrocele.
Staining gonadal lymph vessels with patent blue V is an effective and simple method of visualization of the lymphatic drainage from the testis. Blue-stained lymph vessels could be readily distinguished and preserved during a laparoscopic varicocelectomy, which results in a decrease of hydrocele development. To validate an efficacy of vital staining of lymphatic vessels in avoiding hydrocele formation, a larger series and longer follow-up are necessary.