Laparoscopic ligature of spermatic veins as a method of surgical management of varicocele

Abstract

Ob jec tive: To pres ent the sur gi cal tech nique of lap aro scopic li ga tion sper matic vein in the treatment of varicocele as well as the re sults of this pro ce dure. Material and meth ods: The study was con ducted at the Clinic of Urol ogy, Clin i cal Cen tre of Serbia, dur ing the sev en teen months, from No vember 2012 till March of 2014. Dur ing this time, the thir teen pa tients un der went lap aro scopic li ga tion of sper matic vein. In clud ing fac tors for this type of surgi cal treat ment were clin i cally man i fest varicocele and/or bad find ing of se men. Results: Dur ing the sev en teen months, thir teen patients un der went lap aro scopic sper matic vein lig a ture. The youn gest pa tient was 21 years old, while the oldest pa tient was 38 years old. The me dian was 28.46 years. 6 pa tients had varicocele Gr III, and with 7 patients we ver i fied varicocele Gr II. The du ra tion of sur gery ranged from 15 to 70 min utes, with a me dian of 35.46 min utes. The amount of gas that was insufflated dur ing sur gery ranged from 14.1 l to 45 l, with a me dian of 23:32 lit ters. Three pa tients un derwent lap aro scopic lig a ture of sper matic vein with pres er va tion of sper matic ar tery. In ter ven tions in which un der went pres er va tion of ar tery lasted lon ger (me dian 60 min utes) than it was the case in the group of pa tients with out pres er va tion (the me dian 28.1 min utes). Conclusion: Lap aro scopic li ga tion of sper matic veins is a safe, min i mally in va sive, rapid and ef fec tive proce dures. The level of post op er a tive com pli ca tions is min i mal learn ing curve fast and pa tient dis com fort is min i mized. The pro ce dure is the fi nan cial cost ef fective, es pe cially com pared with the open sur gi cal proce dure. Key words: varicocele, lap a ros copy, lap aro scopic li ga tion of sper matic veins, Valsalva ma neu ver, Tan ner grad ing, Dopp ler ul tra sound.