Endoscopic varicocelectomy by extraperitoneal route: a novel technique

Area of Science:

• Urology
• Minimally Invasive Surgery
• Reproductive Medicine

Background:

• Laparoscopic varicocelectomy (LV) via transabdominal preperitoneal (TAPP) approach carries risks of intraperitoneal injury and may miss collateral veins.
• The extraperitoneal approach for varicocelectomy is underutilized despite its benefits for urological procedures.
• Energy sources used in LV have raised concerns regarding potential trauma to the vas deferens.

Purpose of the Study:

• To evaluate the safety and efficacy of the totally extraperitoneal (TEP) approach for varicocelectomy.
• To perform varicocelectomy without the use of energy sources, minimizing potential trauma.
• To assess the impact of TEP varicocelectomy on semen parameters and fertility outcomes.

Main Methods:

• A cohort of 16 males with bilateral varicocele, subnormal semen parameters, and infertility were treated between January 2000 and March 2005.
• Varicocelectomy was performed using the totally extraperitoneal (TEP) endoscopic technique.
• No energy sources were utilized during the surgical procedure.

Main Results:

• The TEP varicocelectomy was technically successful in all 16 patients, with no visceral injuries, bleeding, or need for conversion.
• Postoperative hydroceles in 11 cases resolved spontaneously within 3 months.
• Mean sperm count increased from 29.25 million/ml to 68.25 million/ml, and motility improved from 26% to 63.18%.
• 11 couples achieved pregnancy within a 2-year follow-up period, with no recurrence or testicular size reduction.

Conclusions:

• Endoscopic varicocelectomy performed via the extraperitoneal route is a safe procedure.
• The TEP approach offers a viable alternative for varicocelectomy, potentially reducing complications associated with laparoscopic methods.
• This technique demonstrates significant improvements in semen parameters and fertility rates for infertile males with varicocele.