Stationary mechanical-assist technology for single-surgeon laparoscopic bilateral varicocelectomy

One potential detraction from the continued application of laparoscopy in the management of varicoceles is the requirement for a skilled assistant, which increases the cost of performing this surgery. This report describes the clinical application of a simple stationary mechanical-assist device to allow a single surgeon to perform bilateral varicocelectomies. The device is attached to the surgical table with a rotary adjusting stem-arm. A cross-mounted sidearm stretches over the patient and forms the attachment to the friction-jointed elbow and wrist attachment to the laparoscope, providing the range of motions similar to a human arm (shoulder, elbow, and wrist). By adjusting the tension at all three levels, changes of the laparoscopic camera portal are possible. Both of the surgeon's hands are then free to work through two operating trocars. The Laprotract arm (Minnesota Scientific, St. Paul, MN) costs $3000 and is autoclavable for quick reutilization. The average time needed to set up the device for bilateral varicocelectomy during eight cases was 2 minutes. The mean procedure time was 65.0 (+/-23.1) minutes, reflecting its ease of use. The electronic image obtained from the stationary mechanical assistant was always steady, and there was no inadvertent wandering from the surgical field. Statistical comparison with 63 open left and 22 open bilateral varicocelectomies during the same time period demonstrated no significant differences in the procedural times. Mechanical-assist technologies can facilitate laparoscopic bilateral varicocelectomies, allowing a single surgeon to perform this operation as quickly as left and bilateral open procedures.