title: Bilateral spermatic cord en bloc ligation by laparoendoscopic single-site surgery: preliminary experience compared to conventional laparoscopy.
abstract: BACKGROUND
  Laparo Endoscopic Single-site Surgery (LESS) represents an evolution of minimally invasive surgery and aims to improve cosmetic outcome and reduce surgical trauma and complications associated with traditional laparoscopy. This study was performed to present our preliminary experience in bilateral spermatic cord ligation with the LESS technique and compare the results with the outcomes of conventional laparoscopic surgery.
  
  
  METHODS
  Between June 2007 and May 2013, 24 patients were referred to our institute for bilateral varicocelectomy. The indications for this type of procedure were bilateral varicocele with impairment of semen parameters or chronic bilateral testicular pain. All procedures were performed via the same surgeon. The patients were divided into two groups according to the type of laparoscopic surgery. Group A included 10 patients underwent LESS technique while group B included the remaining 14 patients that underwent conventional laparoscopy.
  
  
  RESULTS
  The comparison between the two techniques showed some important advantages for LESS: shorter operating time (45.4 min vs. 88.3 (P < .001), shorter hospital stay (16.6 hours vs. 51.4 hours) (P < .001), early return to the normal activity (2.3 days vs. 4.7 days) and better cosmetic outcomes. No conversions from LESS to conventional laparoscopy were necessary and blood loss was insignificant in all patients.All patients in the LESS group reported full satisfaction with the cosmetic outcome, whereas 85.7% of patients after conventional laparoscopy were fully satisfied with cosmesis.
  
  
  CONCLUSIONS
  Bilateral spermatic cord ligation with LESS is an alternative to conventional laparoscopy. The procedure was successfully performed in all patients. The trans-umbilical approach offers the advantage of a better cosmetic result, shorter hospital stay and less postoperative pain.
authors.forename: Salvatore
authors.initials: S
authors.lastname: Micali
authors.forename: Ahmed
authors.initials: A
authors.lastname: Ghaith
authors.affiliation: Department of Urology, University of Modena & Reggio Emilia, Via del Pozzo, 71, Modena 41124, Italy. eugeniomartorana@libero.it.
authors.forename: Eugenio
authors.initials: E
authors.lastname: Martorana
authors.forename: Alessio
authors.initials: A
authors.lastname: Zordani
authors.forename: Angelo
authors.initials: A
authors.lastname: Territo
authors.forename: Giampaolo
authors.initials: G
authors.lastname: Bianchi
mesh_terms: D000293:Adolescent; D000328:Adult; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D007902:Length of Stay; D008026:Ligation; D008297:Male; D061646:Operative Time; D010146:Pain / Q000517:prevention & control; D017060:Patient Satisfaction; D013085:Spermatic Cord / Q000601:surgery*; D013737:Testis; D016896:Treatment Outcome; D014646:Varicocele / Q000601:surgery*; D055815:Young Adult