Application of Indocyanine Green-Labeled Fluorescence Laparoscopy in Inguinal Hernias (Nyhus Types III and IV)

Abstract

Abstract Background: Laparoscopic inguinal hernia (IH) repair presents escalated risks of surgical complications, notably bleeding, particularly in Nyhus types III and IV IHs. In this study, we introduced an innovative technique using indocyanine green-labeled fluorescence laparoscopy to mitigate intraoperative complications, including bleeding and rupture of the hernial sac. Methods: This retrospective study reviewed records of 17 patients who underwent laparoscopic IH repair at Anqing Municipal Hospital between July and August 2023. Intraoperatively, fluorescence imaging was utilized to trace the pathway of the spermatic vessels and outline the boundaries of the hernia sac to facilitate a thorough dissection. Results: The procedure was successfully completed in all 17 patients, with a median operation time of 42 min (range: 30–51 min). Median intraoperative blood loss was 5 ml (range: 3–8 ml). Complete dissection of the hernia sac was achieved in each case without any incidents of sac rupture. Hemodynamic parameters of blood flow within the spermatic artery on postoperative day 1 showed no statistically significant deviations from the preoperative values. Furthermore, during the 2-month follow-up period, there were no cases of seroma formation or hernia recurrence. Conclusion: Employing indocyanine green-labeled fluorescence laparoscopy in Nyhus types III and IV IH repairs significantly reduces intraoperative complications, notably bleeding and rupture of the hernial sac. This technique demonstrated a negligible impact on the hemodynamic parameters of the spermatic artery and reduced the overall surgical time.