Vital blue-dyeing of spermatic lymphatic vessels during laparoscopic varicocelectomy
Article published in Urologia Polska 2006/59/1.

authors

Andrzej Gołębiewski, Marek Królak, Leszek Komasara, Piotr Czauderna: Klinika Chirurgii i Urologii Dzieci i Młodzieży Akademii Medycznej w Gdańsku

keywords

varicocele, laparoscopic varicocelectomy, dye, lymphatic vessels sparing

summary

Introduction. The conventional surgery for varicocele in adolescents and men (ligation of the internal spermatic vessels via a retroperitoneal or laparoscopic approach) is usually successful. The main postoperative complication is hydrocele, which occurs in about 11% of patients. The cause of hydrocele is the disruption of the lymphatic drainage. Identifying the lymphatic vessels that drain the testis and tunica vaginalis with a dye and their preservation should decrease the incidence of postoperative hydroceles. We describe a technique using vital dyes to identify and preserve the lymphatic vessels in adolescent boys during laparoscopic procedure.

The aim of the study. To evaluate the effectiveness and complication rate of usage of two vital dyes (Methylene blue and Patente Blue V) to identify lymphatic vessels during laparoscopic varicocelectomy in adolescent boys.

Materials and method. Thirty boys affected by varicocele grade III underwent left-sided laparoscopic varicocelectomy. Age of the patients ranged from 12 to 16 years. Before surgery 2 ml of methylene blue or Patente Blue V (respectively in 10 and 20 boys) was injected under the tunica dartos on the left side.

Results. In 26 patients (18 of Patente Blue V and 8 in methylene blue group) the dyeing and identification of lymphatic vessels was possible. In these patients the lymphatic sparing laparoscopic varicocelectomy was completed. No adverse reactions- local or generalized were observed. All patient were discharged home on the day of the procedure.

Conclusions. Staining testicular lymph vessels with both methylene blue and Patente Blue V dyes is possible and allows to visualize the lymphatic drainage from the testis and tunica vaginalis. The blue stained lymph vessels could be readily visualized and preserved during the laparoscopic varicocelectomy. To validate usefulness of this method in avoiding hydrocele formation after laparoscopic varicocelectomy in adolescents, a larger series and longer follow up are necessary. Because methylene blue dye is equally effective as Patente Blue but is much cheaper and does not pose a risk of serious adverse reactions, it seems more convenient in clinical practice.

references

1. Kass EJ, Freitas JE, Bour JB: Adolescent varicocele: objective indications for treatment. J Urol 1989, 142, 579-582.
2. Hadziselimovic F, Herzog B, Liebundgut B et al: Testicular and vascular changes in children and adults with varicocele. J Urol 1989, 142, 583-585.
3. Riccabona M, Oswald J, Koen M et al: Optimizing the operative treatment of boys with varicocele: sequential comparison of 4 techniques. J Urol 2003, 169, 666-668.
4. Humphrey GME, Najmaldin AS: Laparoscopy in the management of pediatric varicoceles. J Ped Surg 1997, 32, 1470-1472.
5. Peters CA: Laparoscopy in pediatric urology: challenge and opportunity. Sem Ped Surg, 1996, 5, 16-22.
6. Chan P, Goldstein M: Varicocele: options for management. AUA News 2001, 6, 1-6.
7. Szabo R, Kessler R: Hydrocele following internal spermatic vein ligation: retrospective study and review of the literature. J Urol 1984, 132: 924-925.
8. Oswald J, Korner I, Riccabona M: The use of isosulfan blue to identify lymphatic vessels in the high retroperitoneal ligation of adolescent varicocele ? avoiding postoperative hydrocele. BJU Int 2001, 87, 502-504.
9. Goldstein M, Gilbert BR, Dicker AP et al: Microsurgical inguinal varicocelectomy with delivery of the testis: an artery and lymphatic sparing technique. J Urol 1992, 148, 1808-1811.
10. Kocvara R, Dvoracek J, Sedlacek J et al: Lymphatic sparing laparoscopic varicocelectomy: a microsurgical repair. J Urol 2005, 173, 1751-1754.
11. Berk DR, Johnson DL, Uzieblo A et al: Sentinel lymph node biopsy for cutaneous melanoma: the Stanford experience, 1997-2004. Arch Dermatol 2005, 141, 1016-1022.
12. Simmons RM, Smith SM, Osborne MP: Methylene blue dye as an alternative to isosulfan blue dye for sentinel lymph node localization. Breast J 2001, 7, 181-183.
13. Tan HL, Tecson B, Ee MZ, Tantoco J: Lymphatic sparing, laparoscopic varicocelectomy: a new surgical technique. Pediatr Surg Int 2004, 20, 797-798.
14. Barot P, Neff M, Cantor B et al: Laparoscopic varicocelectomy with lymphatic preservation using methylene blue dye. J Laparoendosc Adv Surg Tech 2004, 14, 183-185.

correspondence