Category: Other, Miscellaneous
Introduction & Objective :
Varicocele is a common disease leading to male infertility. There are variant approaches of varicocelectomy. Microsurgical subinguinal varicocelectomy has been considered the most preferred method due to fewer complications compared with other techniques. However, we may encounter multiple testicular artery branches during subinguinal procedures. This is a significant challenge to identify and preserve all branches. High power optical magnification or Doppler vessel ultrasonography were used to achieve the goal. In our study, we used indocyanine green angiography (ICGA) to target the vessels.
Twenty patients diagnosed with varicocele had infertility and abnormal semen parameters. They underwent indocyanine green angiography assisted microsurgical subinguinal varicocelectomy. After exposure of spermatic cord, 12.5mg of ICG was injected intravenously. We used ICG mode of microscopy to identify the vessels.
The artery ICG signal intensified around 66 seconds after injection. Testicular artery could be identified clearly. One to three branches of the testicular artery were found. Then, venous phase began around 87 seconds. After sparing arteries, all spermatic veins were ligated and transected. In our experience, there were 5 to 10 veins ligated. Total operation time was around 25 minutes. Follow-up sperm analysis showed significant improvement in 55% patients. No complication developed.
ICGA microsurgical subinguinal varicocelectomy is an efficient method for sparing all arteries. The application of ICGA gives surgeons confidence to ligate the vessels. It shortens the operation time and learning curve. It also decreases the incidence of the testicular artery injury.
Jen-Kai Fang– Taichung, Taiwan, China medical university hospital, Taichung, Taichung, Taiwan (Republic of China)
Li-Hsien Tsai– Taichung, Taichung, Taiwan (Republic of China)
Chao-Hsiang Chang– Taichung, Taichung, Taiwan (Republic of China)
Hung-Chieh Chiu– Taichung, Taichung, Taiwan (Republic of China)
China medical university hospital
Taichung, Taichung, Taiwan (Republic of China)
I'm Jen-Kai Fang, from China medical university hospital in Taiwain. I'm second year resident of urology.