MR 32. Macroscopic and microsurgical varicocelectomy: What is the intraoperative difference?

Background and Objective: Many papers reported that microsurgical varicocelectomy was among the best treatment modalities for varicocele. However, the difference of intraoperative anatomic detail between macroscopic and microsurgical varicocele repair in the same spermatic cord has not been well 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 varicoceletomy.

Results: There were significant differences in the average number of internal spermatic artery (1.67 vs. 0.91), internal spermatic vein (6.45 vs. 4.31) and lymphatic (2.93 vs. 1.17) between microscopic and macroscopic procedures (all P<0.001). Meanwhile, an average of (2.14±1.26) internal spermatic veins were 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 were to be ligated at macroscopic procedure.

Conclusions: Microsurgical varicocelectomy can preserve more internal spermatic artery and lymphatic tissue and ligate more veins.