title: Macroscopic and microsurgical varicocelectomy: what's the intraoperative difference?
abstract: OBJECTIVE
  Many authors reported that microsurgical varicocelectomy was among the best treatment modalities for varicocele. However, the difference in intraoperative anatomic detail between macroscopic and microsurgical varicocele repair in the same spermatic cord has not been critically discussed.
  
  
  METHODS
  Between August 2010 and February 2011, 32 men with 42 sides' grade 2-3 varicocele were enrolled in this study. One surgeon firstly mimicked the modified open varicocelectomy by identifying, isolating, and marking the presumed internal spermatic veins, lymphatics, and arteries. Another surgeon then checked the same spermatic cord using operating microscope to investigate the number of missed veins, to be ligated lymphatics and arteries in the "imitative" open varicocelectomy.
  
  
  RESULTS
  There were significant differences in the average number of internal spermatic arteries (1.67 vs. 0.91), internal spermatic veins (6.45 vs. 4.31), and lymphatics (2.93 vs. 1.17) between microscopic and macroscopic procedure (P < 0.001, P < 0.001, P < 0.001, respectively). Meanwhile, an average of 2.14 ± 1.26 internal spermatic veins was missed; among them, 1.63 ± 1.32 internal spermatic veins adherent to the preserved testicular artery were overlooked. The number of 0.69 ± 0.84 lymphatics and 0.74 ± 0.74 arteries were to be ligated in "macroscopic varicocelectomy." A number of 1.07 ± 1.11 lymphatics were neither identified nor ligated. In addition, in 2 cases, the vasal vessels of the vas deferens were to be ligated at macroscopic procedure.
  
  
  CONCLUSIONS
  Microsurgical varicocelectomy could preserve more internal spermatic arteries and lymphatic and ligate more veins which may interpret the superiority of microsurgical varicocele repair.
authors.affiliation: Department of Urology, The Third Affiliated Hospital of Sun Yat-sen University, 600 Tianhe Road, Guangzhou, 510630, China.
authors.forename: Xiaopeng
authors.initials: X
authors.lastname: Liu
authors.forename: Hao
authors.initials: H
authors.lastname: Zhang
authors.forename: Xingxing
authors.initials: X
authors.lastname: Ruan
authors.forename: Hengjun
authors.initials: H
authors.lastname: Xiao
authors.forename: Wentao
authors.initials: W
authors.lastname: Huang
authors.forename: Liaoyuan
authors.initials: L
authors.lastname: Li
authors.forename: Xin
authors.initials: X
authors.lastname: Gao
authors.forename: Yan
authors.initials: Y
authors.lastname: Zhang
mesh_terms: D000293:Adolescent; D000328:Adult; D001158:Arteries / Q000601:surgery; D006801:Humans; D008208:Lymphatic System / Q000601:surgery; D008297:Male; D008866:Microsurgery / Q000379:methods*; D008875:Middle Aged; D012189:Retrospective Studies; D013085:Spermatic Cord / Q000098:blood supply / Q000601:surgery; D016896:Treatment Outcome; D013521:Urologic Surgical Procedures, Male / Q000379:methods*; D014646:Varicocele / Q000601:surgery*; D014680:Veins / Q000601:surgery; D055815:Young Adult