title: The systematic use of intraoperative vascular Doppler ultrasound during microsurgical subinguinal varicocelectomy improves precise identification and preservation of testicular blood supply.
abstract: OBJECTIVE
  To evaluate the impact of systematic use of intraoperative Doppler ultrasound during microsurgical subinguinal varicocele repair.
  
  
  METHODS
  Prospective clinical study.
  
  
  METHODS
  Andrology laboratory and male infertility section of the urology department of a tertiary care hospital.
  
  
  METHODS
  Two hundred and thirteen men with clinical varicocele.
  
  
  METHODS
  Subinguinal microsurgical varicocele ligation using an intraoperative vascular Doppler flow detector.
  
  
  METHODS
  Number of veins ligated, lymphatic spared, arteries identified or accidentally ligated.
  
  
  RESULTS
  A statistically significant greater number of arteries were identified and preserved when intraoperative vascular Doppler was used. In addition, the average number of internal spermatic veins ligated was statistically significantly greater in the same group. Accidental artery ligation occurred in two cases (1.1%) in which the Doppler was not applied. There was no statistically significant difference in number of lymphatics spared between groups.
  
  
  CONCLUSIONS
  Our findings showed that concomitant use of intraoperative vascular Doppler during microsurgical varicocelectomy allows more arterial branches to be preserved, and more internal spermatic veins are likely to be ligated. This device should be considered an attractive tool to improve surgical outcomes and safety.
authors.affiliation: Department of Urology, University of São Paulo, São Paulo 01308-050, Brazil. mcocuzza@uol.com.br
authors.forename: Marcello
authors.initials: M
authors.lastname: Cocuzza
authors.forename: Rodrigo
authors.initials: R
authors.lastname: Pagani
authors.forename: Rafael
authors.initials: R
authors.lastname: Coelho
authors.forename: Miguel
authors.initials: M
authors.lastname: Srougi
authors.forename: Jorge
authors.initials: J
authors.lastname: Hallak
mesh_terms: D000328:Adult; D006801:Humans; D018783:Impotence, Vasculogenic / Q000517:prevention & control; D007248:Infertility, Male / Q000209:etiology / Q000601:surgery; D007264:Inguinal Canal / Q000601:surgery; D007432:Intraoperative Period; D008026:Ligation / Q000379:methods; D008297:Male; D008866:Microsurgery / Q000379:methods*; D016343:Monitoring, Intraoperative / Q000295:instrumentation / Q000379:methods; D011183:Postoperative Complications / Q000517:prevention & control; D013737:Testis / Q000098:blood supply* / Q000601:surgery; D018608:Ultrasonography, Doppler / Q000379:methods*; D013519:Urogenital Surgical Procedures / Q000009:adverse effects / Q000379:methods*; D014646:Varicocele / Q000150:complications / Q000534:rehabilitation / Q000601:surgery*; D014656:Vascular Surgical Procedures / Q000009:adverse effects / Q000379:methods*; D055815:Young Adult