title: Minilaparoscopic varicocelectomy with preservation of testicular artery and lymphatic vessels by using intracorporeal knot-tying technique: five-year experience.
abstract: BACKGROUND
  In this study we present our experience using minilaparoscopic intracorporeal knot tying to ligate internal spermatic veins (ISV) while sparing the spermatic artery and lymphatics.
  
  
  METHODS
  Minilaparoscopic varicocelectomies were performed in 87 patients between January 2004 and January 2009. All varicoceles were detected clinically according to the World Health Organization (WHO) classification and confirmed by scrotal color Doppler ultrasonography. The surgical indications were scrotal symptoms in 71, infertility in 16, and both conditions in 2. Three 3.5 mm minilaparoscopic ports were used for the operation. The ISVs were dissected and then ligated with intracorporeal knot-tying. The testicular artery and lymphatic vessels were carefully preserved to minimize procedure-related complications.
  
  
  RESULTS
  Unilateral laparoscopic varicocelectomy was performed in 21 (24.2%) patients and bilateral in 66 (75.8%). Mean operative time was 71.1 ± 29.2 and 46.8 ± 12.6 min for bilateral and unilateral varicocelectomies, respectively. All patients were discharged within 24 h after surgery. Neither immediate major nor late procedure-related complications were noted. Of the 71 patients with scrotal symptoms, the symptoms completely subsided in 55 (77.5%) and partially subsided in 10 (14.1%). Only one (1.2%) recurrent varicocele was detected within a mean follow-up of 21 months (range = 3-42). Neither hydrocele formation nor testicular atrophy was found during the follow-up period.
  
  
  CONCLUSIONS
  Our 5-year experience revealed that minilaparoscopic varicocelectomy with sparing of artery and lymphatic vessels could safely and effectively ligate all spermatic veins and preserve spermatic arteries and lymphatic channels without leading to a high varicocele persistence or recurrence.
authors.affiliation: Department of Urology, Far Eastern Memorial Hospital, Taipei, Taiwan.
authors.forename: Shiu-Dong
authors.initials: SD
authors.lastname: Chung
authors.forename: Chia-Chang
authors.initials: CC
authors.lastname: Wu
authors.forename: Victor Chia-Hsiang
authors.initials: VC
authors.lastname: Lin
authors.forename: Chen-Hsun
authors.initials: CH
authors.lastname: Ho
authors.forename: Stephen Shei Dei
authors.initials: SS
authors.lastname: Yang
authors.forename: Yao-Chou
authors.initials: YC
authors.lastname: Tsai
mesh_terms: D000293:Adolescent; D000328:Adult; D001158:Arteries / Q000601:surgery*; D004210:Dissection / Q000379:methods; D005500:Follow-Up Studies; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D042601:Lymphatic Vessels / Q000601:surgery*; D008297:Male; D019060:Minimally Invasive Surgical Procedures / Q000379:methods*; D059351:Organ Sparing Treatments / Q000379:methods*; D012008:Recurrence; D013085:Spermatic Cord / Q000098:blood supply; D013536:Suture Techniques; D013737:Testis / Q000098:blood supply*; D018615:Ultrasonography, Doppler, Color; D014646:Varicocele / Q000000981:diagnostic imaging / Q000601:surgery*; D014680:Veins / Q000601:surgery; D055815:Young Adult