Do Not Get Lost in the Spaces of the Spermatic Cord During Subinguinal Microsurgical Varicocelectomy

Mirilas, Petros

doi:10.1111/j.1464-410x.2011.10093_1.x

Cited by 3 publications

(3 citation statements)

References 5 publications

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“…The membranous layer surrounds the internal spermatic vessels and continues posteriorly, to form a pedicle that attaches to the internal spermatic fascia. The vas deferens is similarly surrounded by a membranous layer, which also attaches posteriorly to the internal spermatic fascia with a much shorter pedicle, so that the vas can be perceived as lying directly on the internal spermatic fascia (Mirilas, 2011). The reader can find details about these fasciae of the spermatic cord in one previous work of ours (Mirilas et al, 2008), whereas the membranous pedicle of the internal spermatic vessels is explicitly discussed in another publication (Mirilas, 2011).…”

Section: Anatomic Compartments Of the Spermatic Cordmentioning

confidence: 99%

“…Gaudin et al (1988) described the membranous layer surrounding the internal spermatic vessels as “a delicate translucent vascular sheath.” In general, however, there is lack of understanding of this layer, and it has been misinterpreted as the internal spermatic fascia (Beck et al, 1992; Zini et al, 2006; Zini, 2007a); then, the vas deferens is erroneously placed external to the internal spermatic fascia (ie, in the external compartment). If this mistake is made, then the surgeon risks getting “lost in the spaces” of the spermatic cord (Mirilas, 2011). In such a case, valuable operative time may be lost in an attempt to trace the vas deferens immediately after opening the external spermatic fascia; instead, dissection should be directed deeper and the internal spermatic fascia should also be opened in order to expose the vas deferens in the internal compartment, posterior to the internal spermatic vessels.…”

Section: Anatomic Compartments Of the Spermatic Cordmentioning

confidence: 99%

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Microsurgical Subinguinal Varicocelectomy in Children, Adolescents, and Adults: Surgical Anatomy and Anatomically Justified Technique

Mirilas

Mentessidou

2012

Journal of Andrology

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Microsurgical varicocelectomy has become the gold standard in adults because of low recurrence and postoperative hydrocele rates; it is increasingly applied in children and adolescents. This review aims to provide the surgeon with the necessary surgical anatomy of the spermatic cord and with a step-by-step, anatomically justified description of technique, toward clearer comprehension and improved application. The anatomic compartments of the spermatic cord are delineated by the external and internal spermatic fasciae. Venous drainage of testis-epididymis is accomplished by the internal spermatic, deferential, and external spermatic (cremasteric) veins. All 3 anastomose at the caudal pole of testis, and then via gubernacular veins with the posterior scrotal veins. Another anastomosis exists between a cremasteric branch and anterior scrotal veins, which gives the external pudendal vein. Subinguinal approach offers access to varicose spermatic veins and collaterals. Use of surgical microscope offers identification of small veins, preservation of arteries, lymphatics, and nerves, and appreciation of spermatic cord fasciae, which permits the development of two surgical planes. In the surgical plane of internal spermatic vessels, internal spermatic veins are ligated, whereas the testicular artery and innervation, as well as lymphatics, are preserved. In the plane of cremasteric vessels and vas, cremasteric veins are ligated, whereas the cremasteric artery, vas deferens and its vasculature, lymphatics, and the genital branch of genitofemoral nerve are preserved. Delivery of the testis to ligate gubernacular veins is at the discretion of the surgeon. Finally, venous return is effected by deferential and scrotal veins, or, when gubernacular veins are ligated, by deferential veins only.

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Section: Anatomic Compartments Of the Spermatic Cordmentioning

confidence: 99%

Section: Anatomic Compartments Of the Spermatic Cordmentioning

confidence: 99%

Microsurgical Subinguinal Varicocelectomy in Children, Adolescents, and Adults: Surgical Anatomy and Anatomically Justified Technique

Mirilas

Mentessidou

2012

Journal of Andrology

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show abstract

“…They correctly mention a ‘compartment of the vas’ internal to the internal spermatic fascia. Many experts, however, erroneously state that the vas sits outside the internal spermatic fascia (2). The vas indeed lies internal to the internal spermatic fascia (i.e.…”

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confidence: 99%

Subinguinal Varicocelectomy With Loupes Only, Sans Surgical Microscope

Mirilas

2012

Nephro Urol Mon

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Microstructures of the spermatic cord with three-dimensional reconstruction of sections of the cord and application to varicocele

Yang

Leng

et al. 2020

Systems Biology in Reproductive Medicine

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Do Not Get Lost in the Spaces of the Spermatic Cord During Subinguinal Microsurgical Varicocelectomy

Cited by 3 publications

References 5 publications

Microsurgical Subinguinal Varicocelectomy in Children, Adolescents, and Adults: Surgical Anatomy and Anatomically Justified Technique

Microsurgical Subinguinal Varicocelectomy in Children, Adolescents, and Adults: Surgical Anatomy and Anatomically Justified Technique

Subinguinal Varicocelectomy With Loupes Only, Sans Surgical Microscope

Microstructures of the spermatic cord with three-dimensional reconstruction of sections of the cord and application to varicocele

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