The application value of indocyanine green in assisting vascular identification during microsurgical varicocelectomy in children

Lei Zhang; Yi Sun; Xiangming Yan; Ting Zhang; Zheng Fang; Mingliu Huang; Xu Cao; Mingcui Fu; Hongliang Xia; Yun Zhou; Shu Dai

doi:10.1016/j.jpedsurg.2025.162917

The application value of indocyanine green in assisting vascular identification during microsurgical varicocelectomy in children

J Pediatr Surg. 2026 Jan 9;61(4):162917. doi: 10.1016/j.jpedsurg.2025.162917. Online ahead of print.

Authors

Lei Zhang¹, Yi Sun¹, Xiangming Yan¹, Ting Zhang¹, Zheng Fang¹, Mingliu Huang¹, Xu Cao¹, Mingcui Fu¹, Hongliang Xia¹, Yun Zhou¹, Shu Dai²

Affiliations

¹ Department of Urology, Children's Hospital of Soochow University, Suzhou, Jiangsu, China.
² Department of Urology, Children's Hospital of Soochow University, Suzhou, Jiangsu, China. Electronic address: daishu.0905@163.com.

PMID: 41520817
DOI: 10.1016/j.jpedsurg.2025.162917

Abstract

Objective: To evaluate the feasibility of indocyanine green (ICG) fluorescence imaging in microsurgical varicocelectomy (MVC).

Methods: A retrospective analysis was conducted on the clinical data of 46 pediatric patients with primary varicocele who underwent MVC at the Children's Hospital Affiliated to Soochow University between June 2022 and September 2024. Inclusion criteria encompassed a affected testicular volume at least 2 mL smaller than the contralateral side or a discrepancy exceeding 20 %, along with symptoms such as scrotal heaviness or pain. Guardians were thoroughly informed preoperatively about the role and potential adverse effects of ICG imaging, with intraoperative ICG utilization determined by parental preference. Patients were stratified into the microscopy-only group (control group A, n = 30) and the ICG-assisted group (group B, n = 16). Parameters recorded included arterial visualization time, venous visualization time, preoperative and postoperative testicular volumes, operative duration, postoperative hospital stay, and complications.

Results: A total of 46 pediatric patients (median age 12.0 years, interquartile range: 12.0-13.0 years) with primary varicocele were included, of whom 30 underwent conventional MVC (group A) and 16 received ICG-assisted MVC (group B). Baseline characteristics showed no significant intergroup differences (P > 0.05). Operative duration in group B (42.12 ± 8.31 min) was significantly shorter than in group A (50.03 ± 12.63 min, P = 0.029). In group B, the mean time from ICG injection to spermatic cord arterial visualization was 23.62 ± 5.03 s, and to venous visualization was 40.62 ± 9.51 s. Postoperative affected testicular volumes were 5.94 ± 1.73 mL in group A and 6.56 ± 1.07 mL in group B (P = 0.138). No statistically significant differences were observed between groups in the 1-year postoperative growth rate of the affected testis (median: 0.17 vs. 0.20, P = 0.298) or testicular volume discrepancy (TVD). No complications occurred in group B postoperatively, whereas group A experienced one case of recurrence.

Conclusion: ICG fluorescence imaging facilitates precise and rapid identification of spermatic cord arteries, yielding definitive benefits in arterial preservation and operative time reduction. Additionally, venous visualization enables detection of potential missed ligations. This modality holds promising potential in the management of pediatric varicocele.

Keywords: Indocyanine green; Microsurgical varicocelectomy; Pediatric; Varicocele.