V11-08: New Transscrotal Approach For Robotic Microsurgical Denervation Of The Spermatic Cord With Robotic Microsurgical Varicocelectomy
Microsurgical denervation of the spermatic cord (MDSC) is a treatment option for chronic orchialgia. Up to 20% of patients may develop chronic postoperative subinguinal incisional pain after traditional MDSC. This video illustrates a novel technique and outcomes for a robotic assisted targeted MDSC approach (RMDSC) and varicocelectomy by using Transscrotal approach to avoid any incisional groin pain.
A transscrotal robotic microsurgical approach was developed and performed by using the daVinci Xi robot (Intuitive Surgical, Sunnyvale, CA) in 15 patients (6 RMDSC and 9 RMDSC plus varicocelectomy) from March’17-Sep’17. Selection criteria for the procedures: chronic testicular pain (>3 months), failed standard conservative treatments and negative urologic workup. Pre and post-operative pain was assessed utilizing a standardized externally validated pain assessment tool - PIQ-6 (QualityMetric Inc., Lincoln, RI) and also visual analog scale (VAS). Pain scores were recorded preoperatively and then postoperatively at 1, 3 and 6 months.
Median OR time was 71 minutes for RMDSC and 116 minutes for RMDSC plus varicocelectomy. 73% (11/15) of the patients had a significant decrease in their pain within limited (median 3months) follow up time (Table 1). Scrotal incisions healed with less scar than standard sub-inguinal incisions and none of the patients reported numbness and pain in the incision site. Two patients developed scrotal hematoma that resolved spontaneously.
Conclusion We report the first use of a transscrotal approach for robotic Microsurgical denervation of the spermatic cord and varicocelectomy. The outcomes appear promising. A better cosmetic result without groin pain might be a clinical benefit of this novel approach but further experience to fully evaluate its benefits and limitations is required.