Microsurgical intermediate subinguinal varicocelectomy

Abstract

This study was conducted to introduce a simple modification that can facilitate microsurgical subinguinal varicocelectomy (MSV) especially for surgeons inexperienced in microsurgical technique. A single surgeon performed microsurgical intermediate subinguinal varicocelectomy (MISV) on 52 patients with 61 cases between September 2010 and August 2012. Patient age, varicocele grade, operation time, intraoperative findings, postoperative complications, and 3-month follow-up results were analyzed. Patient mean age was 28 years (range, 15-69 years), and there were 9 bilateral cases. The mean operative time was 51 minutes (range, 34-109 minutes). We compared the first 31 cases to the second 30 cases, to assess investigator experience on operating times. The mean number of ligated veins was 5 (range, 3-10) in internal spermatic vein, 1 (range, 0-4) in external spermatic vein, and 1 (range, 0-3) in gubernacular vein. In 28 patients, the average postoperative sperm concentration at the 3-month follow-up was significantly higher than the preoperative sperm concentration (28.5±18.2×10(6)/mL versus 10.5±23.0×10(6)/mL; P=0.003). Mean motility improved after MSIV (65.7%±18.2% versus 47.2%±21.7%; P=0.004). In conclusion, MISV appears comparable with MSV in terms of the high success rate, low complication rate, and low postoperative pain; and it can be easily accomplished by inexperienced surgeons.

Keywords: Male infertility; Treatment outcome; Varicocele.

Fig. 1

Microsurgical intermediate subinguinal varicocelectomy. (A) A 2- to 3-cm transverse skin incision was made over the external inguinal ring. (B) A short, 1-cm incision on the external inguinal ring incision was made along the right angle clamp, and subsequently further dissection around the upper part of spermatic cord was completed. (C) and (D) As retracting the small silastic drain caudally, the spermatic cord was elevated on a large silastic drain. (E) and (F) We could explore the spermatic cord at approximately the 2-cm upper level compared with the conventional subinguinal level (arrowhead) without an external inguinal ring incision; the venous plexus was less complex with fewer veins at our intermediate subinguinal level (arrow), and the spermatic cord would be more redundant without arterial choking by external spermatic ring. The structure encircled by black silk tie is the preserved internal spermatic artery.