Skip to main content

Is the laparoscopic Palomo procedure for pediatric varicocele safe and effective?

Nine years of unicentric experience



Varicocele is a rare disorder in children that can lead to testicular atrophy and infertility; therefore, radical treatment is frequently required. Whatever treatment is chosen, postoperative complications are fairly common (hydrocele, recurrence, persistence, and testicular atrophy). Laparoscopic varicocelectomy (the laparoscopic Palomo procedure) is one of the surgical options that has recently gained popularity. The aim of this study is to assess the safety and effectiveness of laparoscopic Palomo varicocelectomy by describing a series of patients operated on during a 9 year period at the Royal Hospital for Sick Children in Edinburgh.


This is a retrospective unicentric study including patients operated on between June 1995 and June 2004. All patients preoperatively underwent ultrasound scan of the testicles (color Doppler) and the abdomen. Indications for surgery included symptoms, high-grade varicocele (grade II and III), and testicular atrophy. Pneumoperitoneum was created using carbon dioxide insufflation with intraabdominal pressure up to 12 mmHg. Three 5 mm ports were inserted. The first port was inserted just below the umbilicus (telescope) under direct vision, and the others were inserted at the left flank and in the suprapubic region. All the enlarged spermatic and vas vessels were ligated or clipped. Outcomes and possible intraoperative, postoperative, or long-term complications are described.


Forty-one patients were included in the study. Ninety percent of symptomatic patients improved significantly postoperatively, and 62% of patients with preoperative testicular atrophy showed postoperative catch-up growth of the involved testis. Nevertheless, hydrocele represents the most frequent postoperative complication in this series of patients. Approximately 15% of the patients required some sort of further surgical intervention (12% because of postoperative hydrocele occurrence).


The laparoscopic Palomo procedure is a safe and effective surgical option for the treatment of pediatric varicocele, although it carries a fairly high risk of postoperative hydrocele. Postoperative hydrocele seems to be related to some sort of lymphatic obstruction, therefore lymphatic sparing procedures that can be accomplished laparoscopically should be reconsidered. Nevertheless, their feasibility and effectiveness need to be more carefully assessed.

This is a preview of subscription content, access via your institution.

Fig. 1
Fig. 2


  1. 1.

    al-Abbadi K, Smadi SA (2000) Genital abnormalities and groin hernias in elementary-school children in Aqaba: an epidemiological study. East Mediter Health J 6: 293–298

    CAS  Google Scholar 

  2. 2.

    Akbay E, Cayan S, Doruk E, et al (2000) The prevalence of varicocele and varicocele-related testicular atrophy in Turkish children and adolescents. Br J Urol Int 86: 490–493

    CAS  Google Scholar 

  3. 3.

    Belloli G, D’Agostino S, Pesce C, et al (1993) Varicocele in childhood and adolescence and other testicular anomalies: an epidemiological study. Pediatr Med Chir 15: 159–162

    CAS  PubMed  Google Scholar 

  4. 4.

    Camoglio FS, Cervellione RM, Dipaola G, et al (2001) Idiopathic varicocele in children. Epidemiological study and surgical approach. Minerva Urol Nefrol 53: 189–193

    CAS  PubMed  Google Scholar 

  5. 5.

    Cohen RC (2001) Laparoscopic varicocelectomy with preservation of the testicular artery in adolescent. J Pediatr Surg 36: 394–396

    Article  CAS  PubMed  Google Scholar 

  6. 6.

    Dubin L, Amelar RD (1970) Varicocele size and results of varicocelectomy in selected subfertile men with a varicocele. Fertil Steril 21: 606–609

    CAS  PubMed  Google Scholar 

  7. 7.

    Esposito C, Monguzzi GL, Gonzalez Sabin MA, et al (2000) Laparoscopic treatment of pediatric varicocele: a multicentric study of the Italian Society of Video Surgery in Infancy. J Urol 163: 1944–1946

    Article  CAS  PubMed  Google Scholar 

  8. 8.

    Ficarra V, Sarti A, Novara G, Artibani W (2002) Anterograde scrotal sclerotherapy and varicocele. Asian J Androl 4: 213–219

    Google Scholar 

  9. 9.

    Humphrey GM, Najmaldin AS (1997) Laparoscopy in the management of pediatric varicoceles. J Pediatr Surg 32: 1470–1472

    Article  CAS  PubMed  Google Scholar 

  10. 10.

    Ivanissevich O (1960) Left varicocele due to reflux: experience with 4,470 cases in 42 years. J Int Coll Surg 34: 742–755

    CAS  PubMed  Google Scholar 

  11. 11.

    Iwata G, Deguchi E, Nagashima M, Yanagihara J, Iwai N, Yamada K (1992) Thermography in a child with varicocele. Eur J Pediatr Surg 2: 308–310

    CAS  PubMed  Google Scholar 

  12. 12.

    Kass EJ, Marcol B (1992) Results of varicocele surgery in adolescents: a comparison of techniques. J Urol 148: 694–696

    CAS  PubMed  Google Scholar 

  13. 13.

    Kattan S (2001) The impact of internal spermatic artery ligation during laparoscopic varicocelectomy on recurrence rate and short postoperative outcome. Scand J Urol Nephrol 35: 218–221

    CAS  PubMed  Google Scholar 

  14. 14.

    Lemack GE, Uzzo RG, Schlegel PN, Goldstein M (1998) Microsurgical repair of the adolescent varicocele. J Urol 160: 179–181

    Article  CAS  PubMed  Google Scholar 

  15. 15.

    Liang C, Wang K, Chen J (1997) Epidemiological study of external genitalia in 5,172 adolescents. Zhonghua Yi Xue Za Zhi 77: 15–17

    CAS  PubMed  Google Scholar 

  16. 16.

    Lyon RP, Marshall S, Scott MP (1982) Varicocele in childhood and adolescence: implication in adulthood infertility? Urology 19: 641–644

    Article  CAS  PubMed  Google Scholar 

  17. 17.

    Martino A, Zamparelli M, Cobellis G, Mastroianni L, Amici G (2001) One-trocar surgery: a less invasive videosurgical approach in childhood. J Pediatr Surg 36: 811–814

    CAS  PubMed  Google Scholar 

  18. 18.

    Nakamura M, Namiki M, Okuyama A, Matsui T, Doi Y, Takeyama M, Fujioka H, Nishimune Y, Matsumoto K, Sonoda T (1987) Temperature sensitivity of human spermatogonia and spermatocytes in vitro. Arch Androl 19: 127–132

    CAS  PubMed  Google Scholar 

  19. 19.

    Namiki M, Nakamura M, Okuyama A, Sonoda T, Nishimune Y, Takatsua D, Matsumoto K (1987) Influence of temperature on the function of Sertoli and Leydig cells of human testes. Fertil Steril 47: 475–480

    CAS  PubMed  Google Scholar 

  20. 20.

    Okuyama A, Nakamura M, Namiki M, Takeyama M, Utsunomiya M, Fujioka H, Itatani H, Matsuda M, Matsumoto K, Sonoda T (1988) Surgical repair of varicocele at puberty: preventive treatment for fertility improvement. J Urol 139: 562–564

    CAS  PubMed  Google Scholar 

  21. 21.

    Palomo A (1949) Radical cure of varicocele by a new technique: preliminary report. J Urol 61: 604–607

    Google Scholar 

  22. 22.

    Pintus C, Rodriguez Matas MJ, Manzoni C, et al (2001) Varicocele in pediatric patients: comparative assessment of different therapeutic approaches. Urology 57: 154–157

    Article  CAS  PubMed  Google Scholar 

  23. 23.

    Poddoubnyi IV, Dronov AF, Kovarskii SL, et al (2000) Laparoscopic ligation of testicular veins for varicocele in children. A report of 180 cases. Surg Endosc 14: 1107–1109

    Article  CAS  PubMed  Google Scholar 

  24. 24.

    Prader A (1966) Testicular size: assessment and clinical importance. Triangle 7: 240–243

    CAS  PubMed  Google Scholar 

  25. 25.

    Riccabona M, Oswald J, Koen M, Lusuardi L, et al (2003) Optimising the operative treatment of boys with varicocele: sequential comparison of 4 techniques. J Urol 169: 666–668

    Article  PubMed  Google Scholar 

  26. 26.

    Saypol DC (1981) Varicocele. Int J Androl 2: 61–71

    Google Scholar 

  27. 27.

    Shafik A, Khalil AM, Saleh M (1972) The fascio muscular tube of the spermatic cord: a study of its surgical anatomy and relation to varicocele: a new concept for the pathogenesis of varicocele. Br J Urol 44: 147

    CAS  PubMed  Google Scholar 

  28. 28.

    Stavropoulos NE, Mihailidis I, Hastazeris K, et al (2002) Varicocele in schoolboys. Arch Androl 48: 187–192

    CAS  PubMed  Google Scholar 

  29. 29.

    Sun N, Cheung TT, Khong PL, et al (2001) Varicocele. Laparoscopic clipping and color Doppler follow-up. J Pediatr Surg 36: 1704–1707

    Article  CAS  PubMed  Google Scholar 

  30. 30.

    Szabo R, Kessler R (1984) Hydrocele following internal spermatic vein ligation: a retrospective study and review of the literature. J Urol 132: 924

    CAS  PubMed  Google Scholar 

  31. 31.

    Tauber R, Johnsen N (1994) Anterograde scrotal sclerotherapy for the treatment of varicocele: technique and late results. J Urol 151: 386–390

    CAS  PubMed  Google Scholar 

  32. 32.

    Trombetta C, Liguori G, Bucci C, Cigliato S, Belgrano E (2003) Percutaneous treatment of varicocele. Urol Int 70: 113–118

    Article  PubMed  Google Scholar 

  33. 33.

    Varlet F, Becmeur F (2001) Laparoscopic treatment of varicoceles in children. Multicentric prospective study of 90 cases. Eur J Pediatr Surg 11: 399–403

    Article  CAS  PubMed  Google Scholar 

Download references

Author information



Corresponding author

Correspondence to A. Pini Prato.

Rights and permissions

Reprints and Permissions

About this article

Cite this article

Prato, A.P., MacKinlay, G.A. Is the laparoscopic Palomo procedure for pediatric varicocele safe and effective?. Surg Endosc 20, 660–664 (2006).

Download citation


  • Laparoscopy
  • Varicocele
  • Palomo
  • Hydrocele