Microsurgical phlebectomy of the spermatic cord veins using the 3d NGENUITY visualization system

A total of 120 microsurgical operations were performed with positive results (including 105 operations using a top con OMS 90 microscope (Japan) and 15 operations using a Zeiss microscope and a 3D NGENUITY visualization system) in patients with varicocele. The mean age of men was 33±2,3 years (M±m). The diameter of the veins of the spermatic cord was 3,5±1,2 mm. All patients with varicocele had retrograde blood flow and reflux through the veins of the pampiniform plexus. Varicocele was found on the left in 105 (87%) patients, on the right – in 15 (13%). 25 out of 120 (20,7%) patients had a recurrence of varicocele on the left after high ligation (Ivanissevich operation). Bilateral varicocele was observed in 5 (4,1%) patients out of 120. Primary varicocele was detected in 95 (78,8%) patients, secondary due to veno-obstructive syndromes (May-Thurner syndrome, compression of the left renal vein by the superior mesenteric artery (nutcracker syndrome) was detected in 25 (20,7%) patients. Postoperative complications: scrotal hematoma in 3 cases (2,5%), scrotal edema in 7 cases (5,8%), ischemic orchiepididymitis in 3 cases (2,5%), persistent pain in the scrotum for 6 months in 4 cases (3,3%). One year after microsurgical phlebectomy of the veins of the spermatic cord from the subinguinal approach, no recurrence of varicocele was detected according to ultrasound data. Microsurgical phlebectomy using the NGENUITY 3D visualization system for varicocele allows eliminating chronic venous insufficiency of the testicle with varicose veins of the spermatic cord with minimal early postoperative complications.

1. Male Infertility Available from: https://uroweb.org/wp-content/uploads/EAU-Guidelines-Male-Infertility-2016-2.pdf от 02.03.2024.

2. Chiles, K.A. Cost-effectiveness of varicocele surgery in the era of assisted reproductive technology / K.A. Chiles, P.N. Schlegel // Asian J Androl. – 2016. – N. 18. – P. 259-261.

3. Цуканов, А.Ю. Варикозная болезнь малого таза как причина патоспермии и пути ее коррекции / А.Ю. Цуканов, Р.В. Ляшев // Андрология и генитальная хирургия. – 2014. – № 2. – С. 74-80.

4. Pagani, R.L. Microsurgical varicocele ligation: surgical methodology and associated outcomes / R.L. Pagani, S.J. Ohlander, C.S. Niederberger // Fertility and Sterility. – 2019. – Vol. 111, Is. 3. – P. 415-419.

5. Comparison of outcomes of different varicocelectomy techniques: open inguinal, laparoscopic, and subinguinal microscopic varicocelectomy: a randomized clinical trial / A.M. Al-Kandari [et al.] // Urology. – 2007. – Vol. 69. – P. 417-420.

6. Inguinal and subinguinal micro-varicocelectomy, the optimal surgical management of varicocele: a meta-analysis / J Wang [et al.] // Asian J Androl. – 2015. – Vol. 17. – P. 74-80.

7. A Novel Approach of Microscopic Subinguinal Varicocelectomy with a «Pulling» Strategy / K. Wu [et al.] // Urology. – 2017. – Vol. 104. – P. 97-101.

8. Tatem, A.J. The role of microsurgical varicocelectomy in treating male infertility / A.J. Tatem, R.E. Brannigan // Transl Androl Urol. – 2017. Vol. 6. – P. 722-729.

9. Страхов, С.Н. Варикозное расширение вен гроздевидного сплетения и семенного канатика (варикоцеле) / С.Н. Страхов. – М.: 2001, Изд.: АО «Астра-семь». – 235 с.

10. Varicocele surgery or embolization: Which is better? / D. Cassidy [et al.] // Can Urol Assoc J. – 2012. – Vol. 6. – P. 266-268.