title: Anatomical factors affecting the time required for microsurgical subinguinal varicocelectomy.
abstract: BACKGROUND
  Microsurgical subinguinal varicocelectomy (MSV) is considered an effective and less morbid procedure, but the difficulty in preserving testicular arteries is a limitation of this procedure. We identified the microanatomy encountered during MSV and clarify its significance to the difficulty of the procedure.
  
  
  METHODS
  Three hundred and twenty-six patients who underwent left MSV were evaluated. Detailed intraoperative microanatomy was recorded for each case. A classification system was used to assess the anatomical relationship between the internal spermatic artery and the varicose veins as follows: type I (non-adherent to the veins), type II (adherent to the veins), and type III (surrounded by veins). Type III cases were further divided into types III-a (an arterial pulse) and III-b (a blurred arterial pulse). A linear regression analysis of the factors associated with the length of the operation was used to determine the difficulty of the surgery.
  
  
  RESULTS
  A mean number of 8.2 internal spermatic veins were ligated. Internal spermatic arteries were classified as type I in 14 % of patients, type II in 57 %, and type III in 29 % (III-a in 20 % and III-b in 9 %). A large number of internal spermatic veins and higher internal spermatic artery type were observed significantly more often in grade 3 varicoceles (p < 0.05). The types of internal spermatic arteries (ρ = 0.458) and numbers of internal spermatic veins (ρ = 0.431), cremasteric veins (ρ = 0.197), and gubernacular veins (ρ = 0.119) were significantly associated with the length of the operation (p < 0.05).
  
  
  CONCLUSIONS
  Anatomical factors were associated with the varicocele grade and surgical difficulty. These findings are helpful to perform MSV.
authors.affiliation: Department of Urology, College of Medicine, Seoul National University, 110 Daehak-ro, Jungno-Gu, Seoul, 110-744 Republic of Korea.
authors.forename: Jung Keun
authors.initials: JK
authors.lastname: Lee
authors.affiliation: Department of Urology, College of Medicine, Seoul National University, 110 Daehak-ro, Jungno-Gu, Seoul, 110-744 Republic of Korea.
authors.forename: Ho Young
authors.initials: HY
authors.lastname: Ryu
authors.affiliation: Department of Urology, College of Medicine, Seoul National University, 110 Daehak-ro, Jungno-Gu, Seoul, 110-744 Republic of Korea.
authors.forename: Jae-Seung
authors.initials: JS
authors.lastname: Paick
authors.affiliation: Department of Urology, College of Medicine, Seoul National University, 110 Daehak-ro, Jungno-Gu, Seoul, 110-744 Republic of Korea.
authors.forename: Soo Woong
authors.initials: SW
authors.lastname: Kim
keywords: Microanatomy; Operation time; Subinguinal varicocelectomy; Surgical difficulty; Varicocele