gms | German Medical Science

Background: Varicoceles are believed to be one of the main causes of fertility problems in men and sometimes are held responsible of recurrent scrotal pain. Today laparoscopic surgery is a common treatment and more and more frequently also performed in children. We now introduce our experience in laparoscopic varicocelectomy and present our new single trocar laparoscopy technique.

Materials and methods: A total of 150 patients who underwent laparoscopic varicocelectomy from January 1996 to December 2014 were analyzed in this study. Three patients have been excluded due to prior open surgery. Mean age was 13.5 ± 2.0 years (range 7.2 - 18.6 years). All patients had postoperative checkup within twelve month as outpatients. Possible complications, including recurrence rate, postoperative pain, paresthesia and impaired healing were recorded and compared.

Four different laparoscopic techniques have been used at our institute. In three-trocar techniques, the testicular vessels were isolated after gaining abdominal access via a 10mm umbilical port and two additional ports (10mm+5mm). After dividing the testicular veins, the dorsal peritoneum was sutured.

From March 1996 to March 2008 the testicular veins we cut through using scissors after being clipped with two 10mm clips on each side of the incision (n=100; group A).

From April 2006 to December 2008 we used the harmonic scalpel Ultracision^® to divide the vessels, thus enabling us to avoid the clips (n=13; group B).

From June 2008 to April 2013 we used the 5mm BiClamp^® forceps to divide the vessels via electrocoagulation also enabling us to avoid clips (n=11; group C).

In January 2010 we started to perform the operation in outpatients as single trocar laparoscopic surgery using the newly developed ‘Ei Optik’ (0° lense by Wolf^®, Germany) which has an operating laparoscope of 5mm including a 3.5mm working channel for reusable instruments. Via a 6mm longitudinal umbilical incision the vessels were divided by making two proximal and two distal coagulations with bipolar forceps and a cut in between. Due to its minimal incision, we do not consider it necessary to suture the dorsal peritoneum (n=26; group D).

Results: All operations were performed laparoscopically. There were no conversions from single incision laparoscopy to three trocar laparoscopy. There were no differences in age between the three trocar groups (group A, B and C) and the single trocar group D (p=0.25).

In group A (clipping; n=100), there was a total of five varicocele recurrences (5%). Nine patients (9%) showed postoperative hydrocele and three (3%) showed minor wound infections.

In group B (Ultrasicion^®; n=13) there was one recurrence (7.7%), three patients showed postoperative paresthesia of the inguinal region (23.1%) and one hydrocele occurred (7.7%).

In group C (BiClamp^®; n=11) there was no recurrence. However three patients (27.3%) showed postoperative paresthesia of the inguinal region and one hydrocele occurred (9.1%).

In group D (Eioptik; n=26) there was no recurrence, hydrocele, postoperative paresthesia or wound infection.

Operating time in group D was significantly shorter than in group A, B or C (p<0.001). Mean operating times were 60min. in group A, 54min. in group B, 50min. in group C and 35min. in group D.

Conclusion: Laparoscopic treatment of varicoceles with a single umbilical port is safe and feasible in children and so far presents with shorter operating times and excellent postoperative outcomes, including reduced complication rates and a minimal umbilical scar.