Laparoendoscopic single-site varicocelectomy compared with conventional laparoscopic surgery: a systematic review and meta-analysis

Abstract

PurposeTo present a systematic review and meta-analysis comparing laparoendoscopics single-site varicocelectomy (LESS-V) versus conventional laparoscopic surgery (CTL-V).MethodsA literature search was performed using The Cochrane Library, MEDLINE, EMBASE, Science Citation Index Expanded and Google Scholar. Literature reviewed included meta-analyses, and randomized and nonrandomized prospective studies. We utilized weight mean difference (WMD) to measure hospital stay, time to return normal activity, postoperative pain and improvement of semen parameters and odds ratio (OR) to postoperative complications and cosmetic satisfaction. We used the Cochrane Collaboration’s Review Manager 5.1 software for statistical analysis.ResultsWe identified six publications which strictly met our eligibility criteria. Meta-analysis of extractable data showed that LESS-V was better than CTL-V in postoperative pain (WMD: −0.46; 95 % CI −0.75 to −0.17; p = 0.002), time to convalescence (WMD: −1.4 days; 95 % CI −2.55 to −0.25; p = 0.02) and cosmetic satisfaction (OR 6.86; 95 % CI 2.89–16.28; p < 0.00001). However, CTL-V was better than LESS-V in operative time (WMD 1.96 min, 95 % CI 0.96–2.96; p = 0.0001). There were no differences between LESS-V and CTL-V in hospital stay (WMD: −0.02 days, 95 % CI −0.39 to 0.35; p = 0.92) and postoperative complications (OR 1.13, 95 % CI 0.57–2.21; p = 0.73).ConclusionsThis meta-analysis comparing the efficacy of LESS-V and CTL-V showed that LESS-V was safe, with significantly reduced postoperative pain, shorter recovery time, and better cosmetic outcome.

Hypogonadism is independently associated with varicocele repair in a contemporary cohort of men in the USA

“…and further modified in 1992 by Goldstein et al 15. It was not until recent years, though, that the substantial advantages of microsurgical technique in paternity rates, postoperative complications, and recurrence rates have been studied and confirmed 91016. However, it is a more challenging operation than open repair for several reasons, including the greater number of vessels confronted at a microsurgical level and adjusting to the use of the microscope, which may partially explain the preference for open repair.…”

“…Conclusive evidence supporting definitive and long-term improvement of testosterone levels after varicocelectomy is lacking,5678 and hypogonadism is not considered an indication for varicocele repair according to the current clinical guidelines 13. Multiple studies show that microsurgical technique is superior to laparoscopic and open repairs because of better reproductive outcomes and lower incidence of postoperative complications and recurrence 91011. Nevertheless, microsurgical approach to varicocele repair has not been universally adopted to date.…”