Microlaparoscopic varicocelectomy.

Abstract

OBJECTIVES: To review the development of laparoscopic varicocelectomy from our initial description in 1986 based in the first pioneering works of K. Semm and to describe our latest microlaparoscopic technique that uses 3 mm instruments. METHODS: We use 3 mm reusable trocars with a specially designed telescope and instruments. One port is in the umbilicus the others are in the flanks at this level. Spermatic vessels are identified by firm traction of the testicle. The peritoneum is incised transversally at this level to dissect and ligate the two or three veins usually found here. To shorten operation time and improve results the vascular bundle is ligated en-bloc and when it is bulky, we divide it into two smaller bundles before tying the knot. RESULTS: Field of vision and image brightness is adequate and allows the operator to suture with great precision and ease. Large angular movements of the 3 mm telescope should be made with its trocar. Image brightness depends on the proximity of the lens to the structure being inspected; it worsens when the lens is withdrawn even slightly. Reusable 3 mm instruments can be used hundreds of times and with care they have sufficient strength to permit tying tight even en-bloc ligatures of vascular bundles. Operating times are between 20 and 25 minutes, bilateral operations need about 10 minutes more. Wounds made by the 3 mm trocars are usually self-closing and rarely need to stitch. CONCLUSIONS: Many authors confirm that since we first described the technique 15 years ago laparoscopic varicocelectomy is a safe, quick and easy minimal invasive procedure, less expensive than open techniques or occlusion under radiological control. The Palomo retroperitoneal approach using en-bloc ligatures of the vascular pedicle laparoscopically shortens operative times, the percentage of failures is minimum and postoperative testicular volumes and sperm counts increase. The microlaparoscopic technique not only reduces surgical aggression, but also the risk of complications is less and it does not increase operative difficulty or operation time.