Loupe-assisted versus microscopic varicocelectomy: is there an intraoperative anatomic difference?

Area of Science:

• Urology
• Surgical Techniques
• Medical Device Technology

Background:

• Varicocelectomy is a surgical procedure to correct varicocele, a condition involving enlarged veins in the scrotum.
• Accurate identification of vascular and lymphatic structures within the spermatic cord is crucial for successful varicocelectomy and minimizing complications.

Purpose of the Study:

• To compare the intraoperative anatomical detail differences between loupe-assisted and microscopic varicocelectomy on the same spermatic cord.
• To evaluate the effectiveness of loupe magnification versus operating microscopy in identifying and preserving/ligating specific spermatic cord structures.

Main Methods:

• A comparative study involving 26 men with grade 2-3 varicocele undergoing open inguinal varicocelectomy.
• One surgeon used loupe magnification (×3.5) for initial dissection, followed by a second surgeon using an operating microscope for detailed assessment on the same spermatic cord.

Main Results:

• Microscopic dissection identified significantly more internal spermatic arteries (1.51 vs 0.97), veins (5.70 vs 4.39), and lymphatics (3.52 vs 1.61) compared to loupe assistance (P < 0.001 for all).
• Loupe magnification resulted in missed ligations, including an average of 1.30 veins, 0.55 lymphatics, and 0.36 arteries per side, with many missed veins adhered to the testicular artery.

Conclusions:

• Microscopic varicocelectomy provides superior visualization, enabling more accurate ligation of veins and better preservation of arteries and lymphatics.
• Loupe magnification (×3.5) is insufficient for reliably identifying and dissecting the delicate structures of the spermatic cord during varicocelectomy.