Liu Xiaomeng,Xu Yi,Cui Xiaomeng,et al.Application of indocyanine green-assisted laparoscopic lymphatic preservation in Palomo surgery[J].Journal of Clinical Pediatric Surgery,,():832-836.[doi:10.3760/cma.j.cn101785-20251025-00014]
Application of indocyanine green-assisted laparoscopic lymphatic preservation in Palomo surgery
- Keywords:
- Indocyanine Green; Varicocele; Adolescent
- Abstract:
- Objective To investigate the clinical effect of indocyanine green (ICG)-assisted lymphatic preservation during laparoscopic Palomo surgery.Methods 55 children with varicocele who underwent surgical treatment in the Department of Urology,Capital Center for Children’s Health,Capital Medical University,from January 2025 to July 2025 were selected and divided into an ICG-assisted laparoscopic lymphatic-sparing Palomo surgery group (ICG group,n=24) and a conventional laparoscopic Palomo surgery group (control group,CG group,n=31).According to the preoperative bilateral testicular volume difference,the children were further divided into an ICG-assisted laparoscopic lymphatic-sparing Palomo surgery group with a preoperative bilateral testicular volume difference >20% (ICG-A group,n=10) and a conventional laparoscopic Palomo surgery group with a preoperative bilateral testicular volume difference >20% (CG-A group,n=11).According to the preoperative internal diameter of the spermatic vein,the children were divided into an ICG-assisted laparoscopic lymphatic-sparing Palomo surgery group with a preoperative spermatic vein internal diameter >2.7 mm (ICG-B group,n=18) and a conventional laparoscopic Palomo surgery group with a preoperative spermatic vein internal diameter >2.7 mm (CG-B group,n=18).Ultrasonography was performed at 1,3,and 6 months after surgery to measure the internal diameter of the affected spermatic vein and bilateral testicular volumes,and to evaluate postoperative testicular hydrocele,testicular atrophy,and recurrence.The improvement in affected-side testicular volume was compared between the ICG-A and CG-A groups.The improvement in the internal diameter of the affected spermatic vein was compared between the ICG-B and CG-B groups.Results The affected side was the left side in all children in both groups.There were no statistically significant differences in age or grade between the two groups (P=0.765, P=0.619).No allergic reaction occurred after intraoperative intratesticular injection of ICG in the ICG group.The lymphatic vessels were visualized within 30 seconds,with 1 to 4 vessels observed; they appeared dark green under white-light mode and green fluorecence under near-infrared mode.No testicular atrophy or recurrence occurred in either group.The incidence of testicular hydrocele was significantly lower in the ICG group than in the CG group (0/24 vs. 7/31,P=0.015).The preoperative affected-side testicular volumes in the ICG-A and CG-A groups were (3.55±2.16)cm3 and (3.85±2.01)cm3,respectively,and the affected-side testicular volumes at 6 months after surgery were (8.35±3.95)cm3 and (8.05±3.39)cm3,respectively.There were no statistically significant differences in affected-side testicular volume between the two groups before surgery or at 6 months after surgery (P=0.740,P=0.852).Compared with the preoperative values,affected-side testicular volume increased significantly in both groups at 6 months after surgery (P<0.001).The preoperative internal diameters of the affected spermatic vein in the ICG-B and CG-B groups were [3.25(3.00,3.50)]mm and [3.60(3.25,3.73)]mm,respectively,and the internal diameters of the affected spermatic vein at 6 months after surgery were [1.90(1.70,2.22)]mm and [1.80(1.60,1.93)]mm,respectively.There were no statistically significant differences in the internal diameter of the affected spermatic vein between the two groups before surgery or at 6 months after surgery (P=0.097,P=0.265).Compared with the preoperative values,the internal diameter of the affected spermatic vein decreased significantly in both groups at 6 months after surgery (P<0.001).Conclusion ICG-assisted lymphatic preservation during laparoscopic Palomo surgery is safe and effective,and can significantly reduce the incidence of testicular hydrocele.
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Memo
收稿日期:2025-10-24。
通讯作者:白东升,Email:baids@sohu.com