Evaluating Microsurgical Varicocelectomy in Adolescents: Clinical Efficacy and the Role of Indocyanine Green Fluorescence Imaging

Objective This study aims to evaluate the clinical efficacy of microsurgical varicocelectomy (MVC) in the management of adolescent varicocele, and to investigate the advantages of indocyanine green (ICG) fluorescence imaging in enhancing the intraoperative identification of testicular arteries and veins during MVC Methods A retrospective analysis was conducted on the clinical data of patients who were diagnosed with varicocele and treated surgically at the Children’s Hospital of Soochow University between February 2022 and February 2024. Surgical procedures were documented in detail. Preoperative evaluation and postoperative follow-up were performed via scrotal and testicular Doppler ultrasonography. Patient age, body mass index (BMI), preoperative testicular volume, symptoms, operative duration, length of hospital stay, complications, and testicular catch-up growth were recorded and compared between the two surgical groups. Results A total of 79 patients were included in the study. Among these patients, 45 underwent laparoscopic high varicocelectomies (Palomo technique, LV group), and 34 underwent microsurgical subinguinal varicocelectomies (MVC group). Intraoperative indocyanine green fluorescence imaging was used in 4 patients in the MVC group to assist in the identification of the testicular artery. No significant differences were observed between the LV and MVC groups regarding operative age, BMI, preoperative testicular volume, or presenting symptoms (P > 0.05). The operative time was significantly longer in the MVC group (73.6 ± 11.3 minutes) than in the LV group (35.4 ± 4.6 minutes) (P < 0.01). Compared with the MVC group, the LV group had a shorter hospital stay (2.31 ± 0.47 days vs. 3.05 ± 0.38 days, P < 0.01). Recurrence occurred in 2 patients in the LV group and 1 patient in the MVC group (P = 0.73). Postoperative hydrocele developed in 4 patients in the LV group, whereas none were observed in the MVC group (P < 0.01). Compared with the preoperative measurements, both groups showed a statistically significant increase in postoperative testicular volume (P < 0.01). Preoperative testicular hypotrophy was observed in 29 cases in the MVC group and 39 cases in the LV group. Postoperatively, catch-up growth occurred in 20 cases (69.0%) in the MVC group and 18 cases (46.2%) in the LV group, with the difference being statistically significant (P < 0.05). Conclusion Microsurgical varicocelectomy, by preserving lymphatic vessels and enabling precise ligation of venous branches, significantly reduces the risk of postoperative hydrocele and facilitates preservation of the testicular artery, promoting better catch-up growth of the testis. Although it requires a longer operative time, its lower complication rate supports its broader adoption in pediatric urology. Furthermore, owing to the relatively small caliber of testicular arteries in adolescents, intraoperative identification can be more challenging than in adults. The use of ICG fluorescence imaging enhances the identification of testicular arteries, minimizes the risk of inadvertent arterial ligation, and allows for the detection of residual veins, demonstrating valuable clinical utility.