Surgical techniques and clinical effects of laparoscopic varicocelectomy with testicular artery preservation / 中华泌尿外科杂志

ABSTRACT

Objective:To discuss the surgical techniques and evaluate the clinical effects of laparoscopic varicocelectomy with testicular artery preservation.Methods:In this retrospective study, we collected clinical data of 97 patients with varicocele who underwent laparoscopic varicocelectomy from January 2015 to June 2020. All operations were performed by the same experienced urologist. Conventional laparoscopic varicocelectomy without testicular artery preservation was performed in earlier 35 patients (January 2015 to December 2016), which were taken as control group. The latter 62 patients (January 2017 to June 2020) underwent laparoscopic varicocelectomy with testicular artery preservation were taken as observational group. In observational group, average age was (21.9±6.7)years, there were 47 cases on the left side, 3 cases on the right side and 12 cases bilaterally, totaling 74 sides. There were 22 sides of varicose veinsⅠ, 28 sides of varicose veinsⅡand 24 sides of varicose veins Ⅲ. Clinical manifestations such as scrotal discomfort, pain and scrotal vein masses were observed on 35 sides (47.3%), infertility was observed in 24 cases (38.7%). Average sperm density was (23.7±5.9)×10 6/ml, average sperm motility (grade a+ b) was (33.9±4.1)%. In control group, average age was (23.7±4.6) years, there were 26 cases on the left side, 2 cases on the right side, 7 cases bilaterally, totaling 42 sides. There were 10 sides of varicose veinsⅠ, 17 sides of varicose veinsⅡ, 15 sides of varicose veinsⅢ. Clinical manifestations of scrotal discomfort, pain and scrotal vein masses were observed on 19 sides (45.2%), infertility was observed in 14 cases (40.0%). Average sperm density was (22.3±6.2)×10 6/ml, average sperm motility (grade a+ b) was (32.6±4.8)%.There was no significant statistical difference in preoperative clinical data between two groups ( P>0.05). The observational group followed the procedural steps of freeing the spermatic cord, isolating the testicular artery, and ligating the spermatic vein. The testicular artery was separated by the separating forceps and the electric hook, with the separating forceps holding the spermatic cord fascia in place and the electric hook (without electricity) bluntly separating the blood vessels and lymphatic vessels in the spermatic cord. The operative time, complications, recurrence rate, improvement rate of scrotal symptoms and semen quality, spontaneous pregnancy rate of spouses within 2 years in infertile patients were compared between the two groups. Results:The mean operative time in observational group was longer than control group [(35.8±7.7)min vs.(16.5±5.5)min, P<0.001]. Occurrence of postoperative acute epididymitis was lower in observational group compared to control group [1.4% (1 side) vs. 11.9% (5 sides), P<0.05] . No testicular atrophy (0 side) occurred in observational group, however, this complication could be found in 7.1% (3 sides) of control group ( P<0.05). Improvement rate of scrotal symptoms and semen quality was higher in observational group than that in control group after operations [77.1% (27 sides) vs. 47.4% (9 sides), P<0.05; and 72.6% (45 cases) vs.51.4% (18 cases), P<0.05]. The rates of spousal natural pregnancy within 2 years in infertile patients was higher in observational group than that in control group [70.8% (17 cases) vs. 50.0% (7 cases), P<0.05]. The rates of hydrocele and scrotal edema were similar in two groups [9.5% (7 sides) vs. 9.5 (4 sides)%, P>0.05], and the recurrence rate of varicocele was similar [8.1% (6 sides) vs. 7.1% (3 sides), P>0.05), without statistically significant difference. Conclusions:Using separating forcep and electronic hook can help to separate the testicular artery when performing laparoscopic varicocelectomy. In this operation, to preserve the testicular artery can get better effects an less complications.