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Urologic Laparoscopy pp 164–177Cite as

Laparoscopic Treatment for Varicocele Testis: Current Status

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Part of the book series: Recent Advances in Endourology ((ENDOUROLOGY,volume 1))

Summary

To minimize the invasiveness of surgical treatment for varicocele testis, laparoscopic varicocele ligation was developed in 1990. In principle, the laparoscopic procedure is similar to open high ligation, where the objective is to occlude the internal spermatic veins cephalad to the internal inguinal ring. Thirty-six papers were published in English between 1990 and 1997 and were reviewed. A total of 1551 patients were treated laparoscopically, resulting in a 99.0% success rate, with an average operative time of 60.7 min. Perioperative complications occurred in 5.7% of the patients, the majority of which were minor and subsided without specific treatment. Postoperative hydrocele was noted in 1.3% of the patients. The effects of laparoscopic varicocele ligation were similar to those of open high ligation, with a persistence or recurrence rate of 5.2%, a rate of improvement in semen quality of 58.4%, and a pregnancy rate of 29.1%. With regard to convalescence, the laparoscopic procedure resulted in less postoperative pain and a shorter recovery period in comparison with open high ligation, although the comparison with inguinal/ subinguinal ligation under local anesthesia was not favorable. Patients with bilateral varicocele testes should benefit from the procedure, because the opposite internal spermatic vein could be accessed without additional ports. The major disadvantages of the laparoscopic approach are the requirement of general anesthesia, the possibility of serious complications related to laparoscopic procedures, and the high cost because of the use of disposable instruments. In conclusion, it is now difficult to consider laparoscopic varicocele ligation less invasive than the subinguinal open surgical approach using local anesthesia for unilateral varicocele testis. In the near future, however, further improvements in surgical instruments, particularly microlaparoscopic instruments, may significantly reduce the convalescence period associated with the procedure.

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Authors and Affiliations

  1. Department of Urology, Kansai Medical University, 10-15 Fumizono-cho, Moriguchi, Osaka, 570-8507, Japan

    Tadashi Matsuda

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  1. Tadashi Matsuda
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Editors and Affiliations

  1. Kyoto University, 2-1 Ichinomiya Gakuen-cho, Shimonoseki, Yamaguchi, 751-8503, Japan

    Osamu Yoshida M.D. (Professor, President) (Professor, President)

  2. The University of Toua Graduate School, 2-1 Ichinomiya Gakuen-cho, Shimonoseki, Yamaguchi, 751-8503, Japan

    Osamu Yoshida M.D. (Professor, President) (Professor, President)

  3. Department of Urology, Kyorin University School of Medicine, 6-20-2 Shinkawa, Mitaka, Tokyo, 181-8611, Japan

    Eiji Higashihara M.D. (Professor and Chairman) (Professor and Chairman)

  4. Department of Urology, Nagoya University School of Medicine, 65 Tsurumai, Showa-ku, Nagoya, 466-8550, Japan

    Shinichi Ohshima M.D. (Professor) (Professor)

  5. Department of Urology, Kansai Medical University, 10-15 Fumizono-cho, Moriguchi, Osaka, 570-8507, Japan

    Tadashi Matsuda M.D. (Professor and Chairman) (Professor and Chairman)

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© 1999 The Japanese Society of Endourology and ESWL

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Matsuda, T. (1999). Laparoscopic Treatment for Varicocele Testis: Current Status. In: Yoshida, O., Higashihara, E., Ohshima, S., Matsuda, T. (eds) Urologic Laparoscopy. Recent Advances in Endourology, vol 1. Springer, Tokyo. https://doi.org/10.1007/978-4-431-65898-6_13

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