Dye-assisted lymph vessels sparing laparoscopic varicocelectomy.
OBJECTIVE
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.


METHODS
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.


RESULTS
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.


CONCLUSIONS
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.
Golebiewski
Andrzej
A
Department of Pediatric Surgery and Urology, Medical University of Gdansk, Gdansk, Poland. angol@amg.gda.pl
Krolak
Marek
M
Komasara
Leszek
L
Czauderna
Piotr
P
D000293:Adolescent; D000556:Ambulatory Surgical Procedures; D002648:Child; D004396:Coloring Agents; D005240:Feasibility Studies; D005500:Follow-Up Studies; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D042601:Lymphatic Vessels / Q000033:anatomy & histology*; D008297:Male; D011183:Postoperative Complications / Q000517:prevention & control; D012394:Rosaniline Dyes; D006848:Testicular Hydrocele / Q000517:prevention & control; D013737:Testis / Q000000981:diagnostic imaging; D018608:Ultrasonography, Doppler; D014646:Varicocele / Q000145:classification / Q000601:surgery*
D004396:Coloring Agents; D012394:Rosaniline Dyes; C008769:sulfan blue