title: Efficacy of Indocyanine Green Angiography on Microsurgical Subinguinal Varicocelectomy.
abstract: OBJECTIVE
  Microsurgical subinguinal varicocelectomy is one of the best treatment modalities for varicoceles related to male infertility and scrotal pain. However, the difficulty in identifying testicular arteries, which should be spared, is a limitation of this technique. To visualize and identify the testicular arteries in spermatic cord during the operation, we examined the efficacy of intraoperative indocyanine green angiography (ICGA), which is regularly used in microsurgical neurosurgery.
  
  
  METHODS
  After the exposure of the spermatic cord blood vessels, ICG was injected intravenously under a surgical microscope for observing infrared fluorescence in patients to identify and isolate the testicular artery.
  
  
  RESULTS
  The testicular artery was clearly identified by ICGA and was able to separate under ICGA view. Thereafter, the varicose veins were repeatedly ligated, while preserving a few lymphatic vessels and the spermatic duct. The preserved arteries were confirmed by repeated ICGA at the end of microsurgical operation. The number of arteries identified by ICGA was greater than the number detected by preoperative computed tomography angiogram.
  
  
  CONCLUSIONS
  Microsurgical subinguinal varicocelectomy using intraoperative ICGA facilitated safe and quick surgery by enabling the visualization of the spermatic cord blood vessels. This is the first report to indicate the usefulness of vessel visualization by ICGA during microsurgical subinguinal varicocelectomy.
authors.affiliation: a Department of Urology , Gunma University Graduate School of Medicine , Maebashi , Japan.
authors.forename: Yasuhiro
authors.initials: Y
authors.lastname: Shibata
authors.affiliation: a Department of Urology , Gunma University Graduate School of Medicine , Maebashi , Japan.
authors.forename: Sota
authors.initials: S
authors.lastname: Kurihara
authors.affiliation: a Department of Urology , Gunma University Graduate School of Medicine , Maebashi , Japan.
authors.forename: Seiji
authors.initials: S
authors.lastname: Arai
authors.affiliation: a Department of Urology , Gunma University Graduate School of Medicine , Maebashi , Japan.
authors.forename: Haruo
authors.initials: H
authors.lastname: Kato
authors.affiliation: a Department of Urology , Gunma University Graduate School of Medicine , Maebashi , Japan.
authors.forename: Tomomi
authors.initials: T
authors.lastname: Suzuki
authors.affiliation: a Department of Urology , Gunma University Graduate School of Medicine , Maebashi , Japan.
authors.forename: Yoshiyuki
authors.initials: Y
authors.lastname: Miyazawa
authors.affiliation: a Department of Urology , Gunma University Graduate School of Medicine , Maebashi , Japan.
authors.forename: Hidekazu
authors.initials: H
authors.lastname: Koike
authors.affiliation: a Department of Urology , Gunma University Graduate School of Medicine , Maebashi , Japan.
authors.forename: Kazuto
authors.initials: K
authors.lastname: Ito
authors.affiliation: b Department of Clinical Investigation and Research Unit , Gunma University Graduate School of Medicine , Maebashi , Japan.
authors.forename: Tetsuya
authors.initials: T
authors.lastname: Nakamura
authors.affiliation: a Department of Urology , Gunma University Graduate School of Medicine , Maebashi , Japan.
authors.forename: Kazuhiro
authors.initials: K
authors.lastname: Suzuki
mesh_terms: D000328:Adult; D000792:Angiography; D006801:Humans; D007208:Indocyanine Green; D007248:Infertility, Male / Q000209:etiology / Q000601:surgery*; D008297:Male; D008866:Microsurgery; D013521:Urologic Surgical Procedures, Male; D014646:Varicocele / Q000150:complications / Q000601:surgery*
chemical_list: D007208:Indocyanine Green
keywords: angiography; computed tomography; indocyanine green; microscopic subinguinal varicocelectomy; varicocele