Lymphatic sparing laparoscopic varicocelectomy: a microsurgical repair.
OBJECTIVE
The division of lymphatic vessels during pediatric varicocelectomy is complicated by hydrocele formation, testicular hypertrophy due to intratesticular edema and decline in testicular function. To prevent these complications, we introduced a microsurgical lymphatic sparing dissection into laparoscopic varicocelectomy.


METHODS
We retrospectively compared outcomes in 104 boys who underwent microsurgical laparoscopic repair for grade II to III varicocele between April 1999 and December 2002 to a group of 67 boys operated on using conventional laparoscopy without lymphatic preservation between January 1997 and March 1999. Using 10x to 20x optical magnification, the lymphatic vessels were identified as colorless tubular structures that were easily separated and preserved.


RESULTS
After a mean followup of 17 months there was no significant difference in varicocele recurrence between the 2 groups (6.7% vs 8.9%, p = 0.56). Hydrocele formation and testicular hypertrophy occurred significantly less frequently after microsurgical repair (1.9% and 2.9%, respectively, vs 17.9% and 20.1% in the conventional group, p = 0.0003). No major complications were encountered.


CONCLUSIONS
Preservation of lymphatics in laparoscopic varicocelectomy is technically feasible, and decreases hydrocele formation and the development of testicular hypertrophy. This microsurgical modification is a safe and efficacious alternative for urologists skilled in reconstructive laparoscopy.
Kocvara
Radim
R
Department of Urology, General University Hospital and 1st Medical School Charles University Praha, Institute for Postgraduate Medical Education, Praha, Czech Republic.
Dvorácek
Jan
J
Sedlácek
Josef
J
Díte
Zdenek
Z
Novák
Kvetoslav
K
D000293:Adolescent; D002648:Child; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D008297:Male; D008866:Microsurgery; D012189:Retrospective Studies; D013521:Urologic Surgical Procedures, Male / Q000379:methods; D014646:Varicocele / Q000601:surgery*