title: LigaSure vessel sealing system in laparoscopic Palomo varicocele ligation in children and adolescents.
abstract: OBJECTIVE
  We review our experience with laparoscopic Palomo varicocele ligation using the LigaSure device in children and adolescents.
  
  
  METHODS
  Between June 2003 and December 2004, 25 varicoceles were treated by laparoscopic Palomo varicocele ligation using LigaSure vascular sealing. Patient ages ranged from 10 to 19 years (mean, 14.5 years). Indications for surgery included grade II-III varicocele or ipsilateral testicular hypotrophy. One patient was affected by recurrent contralateral inguinal hernia and 2 presented with an ipsilateral patent processus vaginalis. We placed a 5-mm umbilical port for access, and kept pneumoperitoneum below 15 mm Hg. Under laparoscopic guidance, two additional ports of 3 and 5 mm were inserted in the lower right and left quadrants, respectively. Once the vessels were isolated, the vascular sealant was applied 3-4 times to ensure coagulation of the spermatic vessels; the vessels were then divided with laparoscopic 5-mm scissors. Inguinal hernia and patent processus vaginalis were treated according to Schier's technique. All procedures were performed in our day surgery facility.
  
  
  RESULTS
  Mean operative time was 18 minutes, which is significantly less than the time required in a similar group of 12 patients who underwent laparoscopic clip ligation. There were no perioperative complications. Eleven of 16 patients recovered testicular size. Two patients had postoperative hydrocele: the first was treated successfully with scrotal aspiration, while the other patient required scrotal hydrocelectomy.
  
  
  CONCLUSIONS
  Laparoscopic Palomo varicocele sealing can be performed safely and rapidly and is highly successful in correcting varicoceles in young males. We also found it to be the ideal technique to correct the associated inguinal hernia or patent processus vaginalis.
authors.affiliation: Pediatric Surgery, Second University of Naples, Naples, Italy. antonio.marte@unina2.it
authors.forename: Antonio
authors.initials: A
authors.lastname: Marte
authors.forename: Maria Domenica
authors.initials: MD
authors.lastname: Sabatino
authors.forename: Micaela
authors.initials: M
authors.lastname: Borrelli
authors.forename: Pasquale
authors.initials: P
authors.lastname: Cautiero
authors.forename: Mercedes
authors.initials: M
authors.lastname: Romano
authors.forename: Antonio
authors.initials: A
authors.lastname: Vessella
authors.forename: Pio
authors.initials: P
authors.lastname: Parmeggiani
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D004564:Electrocoagulation / Q000295:instrumentation*; D006488:Hemostasis, Surgical / Q000295:instrumentation*; D006552:Hernia, Inguinal / Q000601:surgery; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D008026:Ligation; D008297:Male; D013737:Testis / Q000098:blood supply; D014646:Varicocele / Q000601:surgery*