Introduction

Varicoceles are present in 20 to 30% of men with infertility; moreover, up to 10% of men with varicoceles experience scrotal pain. Varicocelectomy improves testicular function and may prevent the accelerated decline in sperm parameters and testosterone levels observed in men with varicoceles. Many studies have indicated that microsurgical subinguinal varicocelectomy is one of the best treatment modalities for varicoceles with regard to spontaneous pregnancy outcomes and complication rates; however, the difficulty in identifying testicular arteries that should be spared is a limitation of this technique. We previously reported the usefulness of intraoperative indocyanine green angiography (ICGA) to detect the thin arteries. In the present study, we assessed the feasibility of ICGA during microsurgical subinguinal varicocelectomy in comparison with standard procedures.

Methods

Microsurgical subinguinal varicocelectomy using ICGA was performed in 48 patients with infertility or chronic pain associated with varicoceles. After exposure of the spermatic cord blood vessels, ICG was injected intravenously to identify and isolate the testicular artery. Intraoperative Doppler blood flow meter was also performed in 29 cases to compare both procedures for detection of the artery. Thereafter, the varicose veins were repeatedly ligated, while preserving a few lymphatic vessels and the spermatic duct. Seventy-eight cases without ICGA use were included as the control group, to determine the efficacy of the ICGA procedure.

Results

The testicular artery was clearly identified by ICGA. The average operation time significantly decreased from 81.8 to 66.2 minutes with the use of ICGA. The number of preserved arteries was significantly increased by ICGA from 1.16 to 1.77. In 15 ICGA cases, very thin arteries that were undetectable with normal light view or Doppler study could be preserved.

Conclusions

Microsurgical subinguinal varicocelectomy using intraoperative ICGA enabled a faster procedure and secure preservation of testicular arteries. We believe that this is a significant surgical procedure for the treatment of varicoceles, especially for infertility patients in whom preservation of maximal blood supply is desired.

Funding

none