Retroperitoneal laparoscopic varicocelectomy

Retroperitoneoscopic Varicocelectomy in Adolescents: Long-term Follow-up in Two Italian Centres

BACKGROUND

The varicocele is the most commonly diagnosed pre-pubertal andrological condition with an incidence of 10%-15% between adolescents. The aim of this study was to evaluate the efficacy of retroperitoneoscopic varicocelectomy (RV) in two Italian centres with particular attention to post-operative testicular volume and semen analysis after 18 years of life.

MATERIALS AND METHODS

From 1999 to 2010, 286 adolescents underwent retroperitoneoscopic left varicocelectomy. Of these patients, 67 were evaluated by clinical examination, ultrasound and semen analysis, allowing an adequate long-term follow-up.

RESULTS

Surgery was performed at a mean age of 13 years (range 10-17) without intraoperative complications. There were two recurrences (3%), two left testis hypotrophy (3%) and four hydroceles (6%), not yet undergone surgery because asymptomatic or without tension. Currently, 44 patients accepted to perform semen analysis which showed a reduction in sperm motility in 12 cases, with associated morphological alterations in 3 and reducing number of spermatozoa in one case.

CONCLUSIONS

In consideration of morphological and biomolecular spermatic alterations reported in adolescent varicocele that could interfere with cellular migration, differentiation and nutrition, it is fundamental to consider the correction of varicocele, not only for the classical indications, but also as a choice for arresting the progressive damage that inevitably acts for several years on the adolescent testis. The RV in adolescents is a safe and feasible procedure for experienced paediatric laparoscopic surgeons with early good clinical outcomes, but more studies occur to understand the real impact of adolescent varicocelectomy on testicular function.

Retroperitoneoscopic varicocelectomy in children and adolescents

BACKGROUND/PURPOSE

In the pediatric population the failure rate of sclerotherapy for the treatment of varicocele has been reported to be up to 35%. Therefore, the aim of our study was to evaluate the efficacy of retroperitoneoscopic varicocelectomy (RV) in children and adolescents.

METHODS

A total of 97 patients were operated on for left-sided varicocele using the retroperitoneoscopic approach between January 1999 and July 2003. Median age was 12.3 years (range, 6-16 years). A 10-mm subcostal retroperitoneoscopic port was used. The operation was performed through an operative laparoscope according to Palomo's technique, with the mass division of spermatic vessels after bipolar coagulation below the renal vein. Elective conversion to laparoscopic transperitoneal varicocelectomy was performed in cases of difficulties in identifying the vessels. The postoperative follow-up included clinical and ultrasound assessment (range, 6-48 months).

RESULTS

A total of 17 (17.6%) patients needed elective conversion to laparoscopic transperitoneal varicocelectomy. In RV, the mean operative time was 28 minutes (range, 15-55 minutes), the mean hospital stay was 2 days, persistence rate was 11.2%, and hydrocele occurrence was 6.2%.

CONCLUSIONS

Our results indicate that the RV is an acceptable technique to achieve the high division of the spermatic vessels. The advantage of this anatomic approach is its very low invasiveness.

Comparison of extraperitoneoscopic and transperitoneoscopic techniques for the treatment of bilateral varicocele

BACKGROUND AND PURPOSE

Laparoscopic varicocelectomy has been performed in patients with bilateral varicocele. This procedure could be performed either transperitoneally or extraperitoneally. The purpose of this study was to compare the effectiveness and morbidity of the two approaches.

PATIENTS AND METHODS

Twenty-one patients underwent transperitoneal repair. Twelve of them had complaints of infertility, and nine of them had pain. Eighteen patient underwent extraperitoneal repair. Twelve of them had complaints of infertility, and six of them had pain. All the patients with pain had clinical varicoceles. In each group, three patients with infertility had unilateral subclinical varicoceles.

RESULTS

No significant difference was found in the duration of surgery, artery-vein discrimination, or morbidity between the extraperitoneal and transperitoneal techniques. In both approaches, the previously infertile patients who have been followed more than 6 months had significant improvement in sperm counts and motilities (P < 0.05). There were no significant differences in the improvement in the extraperitoneal and transperitoneal groups.

CONCLUSION

There was no significant difference between the transperitoneal and extraperitoneal techniques in terms of effectiveness and morbidity. The difficulty in identifying the internal spermatic vein and the additional cost of the balloon dissector for the extraperitoneal technique makes us prefer transperitoneal repair.

Laparoscopic varicocelectomy: indication, technique and surgical results

OBJECTIVE

To assess the efficacy of laparoscopic techniques for the operative therapy of varicocele.

PATIENTS AND METHODS

Fifty-one patients who underwent laparoscopic varicocelectomy due to subfertility and/or pain between June 1992 and December 1994 were evaluated.

RESULTS

In all patients, except one with a remaining slight reflux on post-operative Valsalva's manoeuvre, operative therapy was effective and no major complications occurred. The procedure was minimally invasive, effective and, because the anatomy was readily seen, multiple veins and/or collaterals were easily assessed and the surgery precise.

CONCLUSION

The laparoscopic technique is an efficient, minimally invasive operation with optimal results. After a brief period of training the operation can be performed in 15-30 min and is therefore no longer than embolization techniques. Treatment of both sides in one session was not a problem.

Retroperitoneoscopic bilateral spermatic vein ligation

An alternative method for bilateral spermatic vein ligation is presented. With a retroperitoneoscopic approach, the vascular structures are clearly identified, and damage to the intraperitoneal organs, spermatic arteries and lymphatics is minimized. We believe that the potential complications of transperitoneal laparoscopic techniques may be decreased with a retroperitoneoscopic approach.