Varicocelectomy: Microsurgical, subinguinal technique

Section Editor’s note: ‘Y’tube, a new video section of UrologyTimes.com, is a resource for urologists and other clinicians who focus on men’s health. ‘Y’tube covers surgical aspects of a variety of men’s health issues with the ultimate goal of accumulating a library of videos to serve as a reference. Here, three leading groups demonstrate varicocelectomy techniques. All make use of a microdoppler and delicate dissection to identify, isolate, and preserve the testicular artery. Two of the videos demonstrate the subinguinal approach to the varicocele. We have found this to result in less pain and quicker recovery for patients. The third video demonstrates a single-port approach to a laparoscopic varicocelectomy and use of a microdoppler in the laparoscopic setting.

This video describes a microsurgical, subinguinal, artery- and lymphatic-sparing technique of varicocelectomy. The technique includes delivery of the testis, which provides direct visual access to every possible route of venous return, reducing failures and recurrences.

Dr. Alukal: This video from the Cornell group represents the standard approach performed by most andrologists. Relevant details include the identification and preservation of lymphatics, and utilization of a microDoppler (20 MHz). Dr. Goldstein has long been a proponent of delivery of the testis and division of gubernacular and external spermatic veins. Many surgeons believe that this is difficult to accomplish via a subinguinal incision; this video clearly demonstrates the technique while offering tips for making access to the testis easier.

Dr. Hotaling: This video can be considered one of the gold-standard approaches to varicocelectomy. While not all urologists advocate for delivery of the testis, the meticulous microsurgical anatomic dissection of the veins, preservation of the lymphatics, and use of a microdoppler are something that all urologists should consider standard of care for this procedure.

More varicocelectomy videos:

Varicocelectomy: Microscopic subinguinal (Marmar) technique

Varicocelectomy: Single-port laparoscopic technique

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