Microsurgical subinguinal varicocelectomy with testicular delivery

Original Video Article

Microsurgical subinguinal varicocelectomy with testicular delivery

Authors:
Paymon Nourparvar, M.D., Lindsey Herrel, M.D., Wayland Hsiao, M.D.

Capsule:We demonstrate our approach to microsurgical subinguinal varicocelectomy.  A number of useful surgical techniques are highlighted and summarized throughout the video.

Objective:
To demonstrate our approach to the microsurgical subinguinal varicocelectomy with testicular delivery.Design:
An instructional video demonstrating the surgical procedure in a step-by-step manner, highlighting useful surgical techniques.
Setting:
N/A
Patients:
Patients with male factor infertility.
Intervention:
After appropriate patient selection and counseling, varicocelectomy is performed with a subinguinal approach utilizing the surgical microscope.
Main Outcome Measures:
N/A
Results:
A 2.5-cm subinguinal incision was made and the testicle was then delivered. Through the operating microscope at 10-20X magnification, internal spermatic veins were identified and ligated. Smaller veins were taken with electrocautery. The testicular artery was identified using the microdoppler probe. We employ hydrodissection in identifying and isolating the testicular artery. The spermatic cord is then repeatedly examined until no veins other than deferential veins remain. The gubernaculum is also thinned sufficiently so that veins on both sides can be identified and ligated. Testicular delivery was performed and external spermatic veins as well as gubernacular veins ligated.
Conclusions:
We demonstrate our approach to microsurgical subinguinal varicocelectomy. Use of the operating microscope, the microdoppler probe and black and white sutures aid in efficiency. Testicular delivery is useful to ligate external spermatic veins as well as gubernacular veins.

References
1. Goldstein M, Gilbert BR, Dicker AP, Dwosh J, Gnecco C. Microsurgical inguinal varicocelectomy with delivery of the testis: an artery and lymphatic sparing technique. J Urol 1992;148:1808–11.
2. Marmar JL, DeBenedictis TJ, Praiss D. The management of varicoceles by microdissection of the spermatic cord at the external inguinal ring. Fertil Steril 1985;43:583–8.

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