title: Technical standardization of laparoscopic lymphatic sparing varicocelectomy in children using isosulfan blue.
abstract: OBJECTIVE
  The lymphatic preservation to prevent hydrocele formation after laparoscopic varicocelectomy is essential. Lymphatic sparing procedures using scrotal injection give a rate of mapping failures of 20%-30%. The aim of the present study is to standardize the technique of injection to perform a lymphatic sparing procedure in case of laparoscopic varicocelectomy.
  
  
  METHODS
  We retrospectively evaluated 50 patients who underwent laparoscopic varicocelectomy from July 2010 to July 2013. Patients were divided into two groups: G1 (25 patients) those who underwent a classical isosulfan blue scrotal intra-dartos injection and G2 (25 patients) those who underwent the new standardized isosulfan blue scrotal intra-dartos/intra-testicular injection.
  
  
  RESULTS
  In G1 lymphatic vessels were identified as blue coloured in 19/25 of cases (76%), in G2 in 25/25 of cases (100%). The results were analyzed using test χ(2) with Yates' correction and there was a statistically significant difference (χ(2)=0.05,1) between G2 and G1. Postoperative hydrocele was noted in 2/6 patients of G1 in whom the lymphatic vessels were not identified.
  
  
  CONCLUSIONS
  Laparoscopic lymphatic sparing varicocelectomy is an effective procedure to adopt in children with varicocele. The intra-dartos/intra-testicular injection of isosulfan blue is significantly better than the previously described intra-dartos injection, permitting to identify lymphatic vessels in 100% of cases in our series. No allergy to isosulfan blue was reported in both groups.
authors.affiliation: Department of Medical Translational Sciences, Pediatric Surgery, "Federico II" University of Naples, Naples, Italy. Electronic address: ciroespo@unina.it.
authors.forename: Ciro
authors.initials: C
authors.lastname: Esposito
authors.affiliation: Department of Medical Translational Sciences, Pediatric Surgery, "Federico II" University of Naples, Naples, Italy.
authors.forename: Marianna
authors.initials: M
authors.lastname: Iaquinto
authors.affiliation: Department of Medical Translational Sciences, Pediatric Surgery, "Federico II" University of Naples, Naples, Italy.
authors.forename: Maria
authors.initials: M
authors.lastname: Escolino
authors.affiliation: Department of Medical Translational Sciences, Pediatric Surgery, "Federico II" University of Naples, Naples, Italy.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Cortese
authors.affiliation: Department of Medical Translational Sciences, Pediatric Surgery, "Federico II" University of Naples, Naples, Italy.
authors.forename: Teresa
authors.initials: T
authors.lastname: De Pascale
authors.affiliation: Department of Pediatric Surgery, San Bortolo Hospital, Vicenza, Italy.
authors.forename: Fabio
authors.initials: F
authors.lastname: Chiarenza
authors.affiliation: Department of Medical Translational Sciences, Pediatric Surgery, "Federico II" University of Naples, Naples, Italy.
authors.forename: Mariapina
authors.initials: M
authors.lastname: Cerulo
authors.affiliation: Department of Medical Translational Sciences, Pediatric Surgery, "Federico II" University of Naples, Naples, Italy.
authors.forename: Alessandro
authors.initials: A
authors.lastname: Settimi
mesh_terms: D000293:Adolescent; D002648:Child; D004396:Coloring Agents; D006801:Humans; D010535:Laparoscopy / Q000379:methods* / Q000592:standards; D042601:Lymphatic Vessels; D008297:Male; D011183:Postoperative Complications / Q000517:prevention & control; D012189:Retrospective Studies; D012394:Rosaniline Dyes; D006848:Testicular Hydrocele / Q000209:etiology / Q000517:prevention & control; D016896:Treatment Outcome; D013521:Urologic Surgical Procedures, Male / Q000379:methods* / Q000592:standards; D014646:Varicocele / Q000601:surgery*
chemical_list: D004396:Coloring Agents; D012394:Rosaniline Dyes; C025484:iso-sulfan blue
keywords: Blue; Children; Complication; Hydrocele; Lymphatic sparing procedure; Varicocele