title: [Suprapubis-assisted umbilical laparoendoscopic mini-dual-site surgery for varicocele: a report of 80 cases].
abstract: OBJECTIVE
  To study the safety, effectiveness and feasibility of suprapubis-assisted umbilical laparoendoscopic mini-dual-site surgery (SAU-LEMDS) in the treatment of varicocele.
  
  
  METHODS
  This study included 80 varicocele patients aged 24 - 44 (mean 28.5 +/- 2.6) years, 25 cases of grade I, 45 cases of grade II and 10 cases of grade III, 58 cases in the left side, 6 in the right and 16 in both sides, and all with asthenospermia. The patients were treated by SAU-LEMDS under subarachnoid anesthesia combined with general anesthesia in a supine position with a head-down-feet-up slope of 15 degrees. Two 5 mm trocars were inserted bilaterally at the umbilical edge, one with a 5 mm 30 degrees laparoscope placed in it, and another into the abdominal cavity below the pubic hairline with a 5 mm laparoendoscopic clipper placed in it. The operation procedure was similar to that of standard laparoscopic ligation of spermatic veins, with reservation of the spermatic artery and double-ligation of spermatic veins. And the procedure was repeated for the contralateral lesion in the bilateral cases. Postoperative follow-up was conducted for the incidences of orchiatrophy and testicular hydrocele and changes of seminal parameters.
  
  
  RESULTS
  All the operations were successful, with the mean operation time of (10 +/- 5.0) min (range 8 to 25 min) for the unilateral cases and (18 +/- 6.5) min (range 15 to 30 min) for the bilateral cases, the mean blood loss of (1.5 +/- 0.5) ml (range 1 to 2 ml), and the mean postoperative hospital stay of (2 +/- 0.5) d (range 1.5 to 3 d). The patients were followed up for 6 -24 (12 +/- 2.5) months, which showed significant improvement in sperm motility as compared with the baseline ([28.53 +/- 5.21] vs [19.62 +/- 3.56]%, P < 0.05), with 28 cases (35.0%) restored to normal. Recurrence was found in 4 cases (5.0%). Testicular hydrocele occurred in 7 cases (8.75%), but orchiatrophy in none. The scars in the umbilicus and suprapubis were invisible because of the wrinkles and pubic hair.
  
  
  CONCLUSIONS
  SAU-LEMDS is safe, effective and feasible for the treatment of varicocele. It is superior to umbilical laparoendoscopic single-site surgery (U-LESS) for its less invasiveness, simpler operation, and better cosmetic appearance.
authors.forename: Dao-Sheng
authors.initials: DS
authors.lastname: Luo
authors.forename: Jun-Hua
authors.initials: JH
authors.lastname: Mo
authors.forename: Mu
authors.initials: M
authors.lastname: Li
authors.forename: Zeng-Qiang
authors.initials: ZQ
authors.lastname: Zhang
authors.forename: Jian-Jun
authors.initials: JJ
authors.lastname: Lu
authors.forename: Zhen-Feng
authors.initials: ZF
authors.lastname: Liang
authors.forename: Qi-Wu
authors.initials: QW
authors.lastname: Mi
authors.forename: Xiang-Zhou
authors.initials: XZ
authors.lastname: Sun
authors.forename: Chun-Hua
authors.initials: CH
authors.lastname: Deng
mesh_terms: D000328:Adult; D053627:Asthenozoospermia; D006801:Humans; D010535:Laparoscopy / Q000009:adverse effects / Q000379:methods*; D007902:Length of Stay; D008026:Ligation / Q000379:methods; D008297:Male; D061646:Operative Time; D011184:Postoperative Period; D012008:Recurrence; D013085:Spermatic Cord / Q000098:blood supply*; D006848:Testicular Hydrocele / Q000209:etiology; D016896:Treatment Outcome; D014472:Umbilicus; D014646:Varicocele / Q000601:surgery*; D014680:Veins