doiSerbia

Laparoscopic ligature of spermatic veins as a method of surgical management of varicocele

Kajmaković B.M. (Clinical Centre of Serbia, Clinic of Urology, Belgrade)
Džamić Z.M. (Clinical Centre of Serbia, Clinic of Urology, Belgrade + Faculty of Medicine, Belgrade)
Dragičević S. (Clinical Centre of Serbia, Clinic of Urology, Belgrade)
Aćimović M. (Clinical Centre of Serbia, Clinic of Urology, Belgrade + Faculty of Medicine, Belgrade)
Milojević B. (Clinical Centre of Serbia, Clinic of Urology, Belgrade)
Hadži Đokić J. (Serbian Academy of Sciences and Arts, Belgrade)

Objective: To present the surgical technique of laparoscopic ligation spermatic vein in the treatment of varicocele as well as the results of this procedure. Material and methods: The study was conducted at the Clinic of Urology, Clinical Centre of Serbia, during the seventeen months, from November 2012 till March of 2014. During this time, the thirteen patients underwent laparoscopic ligation of spermatic vein. Including factors for this type of surgical treatment were clinically manifest varicocele and/or bad finding of semen. Results: During the seventeen months, thirteen patients underwent laparoscopic spermatic vein ligature. The youngest patient was 21 years old, while the oldest patient was 38 years old. The median was 28.46 years. 6 patients had varicocele Gr III, and with 7 patients we verified varicocele Gr II. The duration of surgery ranged from 15 to 70 minutes, with a median of 35.46 minutes. The amount of gas that was insufflated during surgery ranged from 14.1 l to 45 l, with a median of 23:32 litters. Three patients underwent laparoscopic ligature of spermatic vein with preservation of spermatic artery. Interventions in which underwent preservation of artery lasted longer (median 60 minutes) than it was the case in the group of patients without preservation (the median 28.1 minutes). Conclusion: Laparoscopic ligation of spermatic veins is a safe, minimally invasive, rapid and effective procedures. The level of postoperative complications is minimal learning curve fast and patient discomfort is minimized. The procedure is the financial cost effective, especially compared with the open surgical procedure.

Keywords: varicocele, laparoscopy, laparoscopic ligation of spermatic veins, Valsalva maneuver, Tanner grading, Doppler ultrasound