V04-10: Microsurgical Subinguinal Varicocelectomy with Testicular Delivery: Modifications and Tricks
We speculate that varicocele, like other chronic vascular diseases, not only lead to high temperature and reflux toxic metabolites, but also cause damage to testes directly by varicose. In addition, previous studies demonstrated that the number of internal spermatic veins identified in spermatic cord dissections was significantly higher in subinguinal than that in inguinal plane. Based on these questions above, we wonder if there is an approach that could eliminate the pathogenic risk factors to the most extent with minimal complications. We thus developed a novel approach of microsurgical subinguinal varicocelectomy with “spermatic cord double traction and varicose gubernacular and external veins stripping strategy” (MSV-STVS).
During the MSV-STVS, the testis is delivered through the incision, and the gubernacular veins and external spermatic veins are not only ligated as conventional approach, but stripped. After the testis being returned to the scrotum, the cord is delivered away from the external ring and fixed by 20F rubber surgical drain with continuous traction. The microsurgical procedure is performed under 8-15× power magnification. The external and internal spermatic fasciae are opened firstly. The vas deferent and associated vasculature are then isolated and preserved under a plastic strip. Then another rubber band is applied to retract the isolated cord downward. Tension is adjusted to ensure arterial flow, judged by microdoppler. All the identi?ed arteries and lymphatics are dissected and preserved. The internal spermatic veins are doubly ligated with clips. We retrospectively reviewed 52 oligoasthenospermic patients with clinical varicocele who underwent MSV-STVS in our hospital.
The progressive sperm count of the patients increased from a median preoperative value of 8.21×106 to 22.24×106. 40.3% couples achieved natural pregnancies. An average of 9.5 internal spermatic veins was found in the left side and 9.6 veins in right side, the number of which is fewer than those reported in previous studies.
The stripping strategy eliminates the potential damages caused by varicose veins to testis. The spermatic cord double traction strategy may provide the access to ligate the veins at inguinal level, reducing the operation difficulty. With our experience, MSV-STVS can achieve reliable sperm quality improvement for oligoasthenospermic patients. The technique is a safe and effective approach for varicocele treatment.