Simultaneous laparoscopic extraperitoneal indocyanine green (ICG)-guided varicocelectomy and inguinal hernia repair in a patient with recurrent varicocele

Abstract

Introduction While microsurgical varicocelectomy is considered the gold standard for treatment, laparoscopic varicocelectomy remains a viable alternative. The use of indocyanine green (ICG) during varicocelectomy can enhance the differentiation of vascular structures, making it easier to distinguish the testicular arteries from the veins. Objective This report presents the technique for laparoscopic extraperitoneal ICG-guided varicocelectomy with simultaneous inguinal hernia repair. Methods A grade 3 varicocele was detected in a patient with a history of two previous microsurgical varicocelectomies, who presented with recurrent pain in the upper part of the left testis for the last three months. Additionally, a left inguinal hernia was also detected, and it was decided to perform the varicocelectomy and hernia repair laparoscopically. Results The total surgical time was 70 minutes. Two mL of ICG was administered intravenously after the spermatic cord contents were exposed. One testicular artery was observed and preserved, and two internal spermatic veins were clipped and cut. No early or late complications were detected. The patient reported being pain-free during the six-month follow-up period. Conclusions Due to the potential issues and technical difficulties that tertiary varicocelectomy may present, the laparoscopic varicocelectomy approach should also be kept in mind as a viable option. The use of ICG is a very effective method for preserving the testicular arteries. Simultaneous extraperitoneal hernia repair can be performed safely and proves to be effective. Disclosure No