To investigate the feasibility of applying indocyanine green fluorescence imaging technique to preserve thelymphatic vessels of the spermatic cordduring laparoscopic Palomo.

The clinical data of 51 patients in Guangzhou Women and Children Medical Center with primary varicocele were analyzed from June 2020 to December 2021. They were randomly divided into 2 groups. Twenty-five cases in the research group underwent ICG-aided laparoscopic Palomo to preserve lymphatic vessels. 1ml of indocyanine green solution (2.5 mg/ml) was injected into the testis of the affected side during the operation, the lymphatic vessels of the spermatic cord were identified and preserved under laparoscopy. Twenty-six cases in the control group received traditional laparoscopic Palomo. The common data, operation time, intraoperative blood loss and postoperative recovery were compared.

All the operations were successfully completed without conversion to open surgery. The lymphatic vessels of the spermatic cord were successfully identified in the research group, with 2-3 lymphatic vessels preserved and a median development time of 20 s (15-30 s). The operation time had no significant difference between the two groups. The rate of postoperative hydrocele testis in control group was higher than that of the research group (P=0.041). The relapse and testicular atrophy had no significant difference between the two groups. The postoperative bilateral testicular volume of the two groups increased significantly (P<0.001).

The application of indocyanine green fluorescence imaging technique for preserving the lymphatic vessels of the spermatic cord during laparoscopic Palomo is safe and effective, and allows for rapid and accurate identification of the lymphatic vessels, avoiding postoperative complications such as hydrocele testis.