V7-12: A NOVEL LAPAROSCOPIC SURGICAL METHOD FOR COEXISTENCE OF TESTICULAR VARICOCELE AND IPSILATERAL HYDROCELE
Video
Introductions and ObjectivesHydrocele is a common clinical problem in children worldwide, and the main cause is a congenital patent processus vaginalis (PPV)._x000D_ We experienced a pediatric case with left-sided communicating hydrocele and ipsilateral varicocele undergoing simultaneous minimally-invasive laparoscopic repair.
Methods
Case:An 11-year-old boy, with left sided scrotal mass, had been diagnosed as testicular varicocele in a clinic. He was sent to our hospital for minimally-invasive treatment._x000D_ At the initial visit, not only left-sided testicular varicocele, but also left-sided hydrocele were confirmed. Simultaneous laparoscopic repair of both diseases were planned._x000D_ Operative procedures: The patient was in a Trendelenburg position (15-degree head-down tilt) under general anesthesia. _x000D_ Laparoscopic repair of the left-sided varicocele using 3 5mm trocars followed by laparoscopic extraperitoneal repair of PPV using 2 small left inguinal incisions were scheduled._x000D_ Initially, laparoscopic high ligation of testicular veins were performed. For closing PPV, pre-peritoneal space was dissected, and a 5mm left inguinal skin incision was made. Through this incision, a 16 gauge vascular access needle was inserted into the pre-peritoneal space, and a 2-0 silk suture was inserted through the sheath of this 16 gauge needle. The 2-0 silk was trapped by 4-0 nylon suture loop via another 16 gauge needle, and was retracted through the same incision. The 2-0 silk suture was tied in the inguinal incision wound, resulting in partial closure of PPV. The same procedures were performed 6 times from lateral to medial direction. Finally, PPV was almost closed, and additional metal clips for final closure of the median peritoneum were used.
Results
Eight months after operation, neither left-sided hydrocele nor varicocele was found. Successful simultaneous minimally-invasive laparoscopic repair was performed in a pediatric case with left-sided communicating hydrocele and ipsilateral varicocele.
Conclusions
This procedure is easy for experienced laparoscopic surgeon, and is a safe procedure.?@
Funding: None