Laparoscopic “en-bloc” ligation of spermatic veins

Abstract

Laparoscopic varicocelectomy is suggested only for II-III grade bilateral varicocele. The optical magnification granted by videosurgical techniques, prevents damaging testicular arteries; this possibility, however, requires a considerable amount of time. We performed a laparoscopic “en-bloc” ligation without sparing the artery on 13 patients with bilateral varicocele in order to assess eventual changes in gonadal volume. 10 patients underwent bilateral “en-bloc” ligation of spermatic vessels with an average operating time of 21 minutes. In 3 other patients, “en-bloc” ligation was performed on the right side while on the left side the artery was identified and saved; in these cases the average operating time was 33 minutes. After an average follow-up period of 19 months no cases of testicle atrophy nor of hydrocele were reported. ColorDoppler sonography, performed 3 months later on the 10 patients treated by bilateral “en-bloc” ligation, showed no persistent reflux. No case of homolateral persistent reflux was encountered in the 3 patients who underwent only right-side “en-bloc” ligation, but on the left side, where selective ligation had been performed, persistence of reflux was registered in one patient. Our experience has confirmed that laparoscopic “en-bloc” ligation of the internal spermatic pedicle, sparing vasa deferentia, prevents the persistence of reflux in all cases and allows a reduction in operating time. The opportunity of treating a pathology like bilateral varicocele by means of laparoscopy, which requires general anaesthesia, needs further confirmation and a larger number of case histories.