V1589: Microsurgical Subinguinal Varicocelectomy

Video

Introduction and Objectives
Varicoceles are found in 40% of men with primary infertility and in up to 70-81% of men with secondary infertility. Varicocelectomy improves testicular function and may halt the accelerated decline in sperm parameters and testosterone levels seen in men with varicoceles.

Methods
In this video, we demonstrate our approach to the microsurgical subinguinal varicocelectomy. Hydrodissection is useful in identifying and isolating the testicular artery. We then repeatedly run the spermatic cord and ligate cremaster veins until only deferential veins remain. With testicular delivery, external spermatic and gubernacular veins are ligated.

Results
We effectively demonstrate our approach for microsurgical subinguinal varicocelectomy with testicular delivery. All internal spermatic veins are ligated with sparing of testicular arteries and lymphatic vessels. Cremaster veins are ligated and cremaster arteries are also identified and spared. Finally, delivery of the testis allows visualization and ligation of external spermatic veins as well as gubernacular veins. With the conclusion of testicular delivery, all venous return is through the deferential veins.

Conclusions
Microsurgical subinguinal varicocelectomy is a successful surgical approach in managing varicoceles, both in the setting of infertility and of chronic pain associated with varicoceles.

Funding: none