Yiğit AKIN, Mutlu ATEŞ, Selçuk YÜCEL, İşıl BAŞARA, Orçun ÇELİK, Aliseydi BOZKURT, Barış NUHOĞLU

Comparison of different ligation techniques in laparoscopic varicocelectomy

To evaluate the effects of different intracorporeal ligation techniques with titanium clips, Plasma Trisector (Gyrus, USA) (PTG), and surgical silk on bilateral laparoscopic varicocelectomy (LPVx). Materials and methods: Between May 2009 and August 2012, 100 patients who underwent bilateral LPVx were evaluated. The demographic parameters of patients, preoperative radiological findings, semen analysis, operative data, and follow-up were recorded. All of the patients were divided into 3 groups, randomized prospectively. The patients whose veins were ligated by 5-mm titanium clips were included in group I, those whose veins were ligated by PTG were included in group II, and those whose veins were ligated by surgical silk were included in group III. The recorded data of the groups were analyzed. Results: Mean follow-up time was 18.8 ± 1.1 months. According to the demographics of age, body mass index, spermiogram, and diameter of veins before surgery, there were no statistical differences between any of the groups (P > 0.05). However, operation time was longer in group III (P < 0.0001), while total numbers of ligated veins did not differ among the groups (P > 0.05). Additionally, hospital stay, oral intake, and complications were not different among the groups (P > 0.05). In follow-up the sperm count analysis was higher than the preoperative count analysis for all of the groups (P < 0.05). Conclusion: PTG may provide a shorter operation time than using titanium clips and/or surgical silk in LPVx. Additionally, PTG may increase sperm count with fewer complications than the other ligation techniques in LPVx. Therefore, PTG may be the new candidate electrosurgical standard device for LPVx in the nearby future.

Anahtar Kelimeler:

Key words: Complications, electrosurgery, laparoscopy, ligation techniques, varicocele, varicocelectomy

Comparison of different ligation techniques in laparoscopic varicocelectomy

Keywords:

Key words: Complications, electrosurgery, laparoscopy, ligation techniques, varicocele, varicocelectomy,

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Zini A, Blumenfeld A, Libman J, Willis J. Beneficial effect of microsurgical varicocelectomy on human sperm DNA integrity. Hum Reprod 2005; 20: 1018–21.
Chan P. Management options of varicoceles. Indian J Urol 2011; 27: 65–73.
Aaberg RA, Vancaillie TG, Schuessler WW. Laparoscopic varicocele ligation: a new technique. Fertil Steril 1991; 56: 776–7.
Glassberg KI, Poon SA, Gjertson CK, DeCastro GJ, Misseri R. Laparoscopic lymphatic sparing varicocelectomy in adolescents. J Urol 2008; 180: 326–30.
Mitropoulos D, Artibani W, Graefen M, Remzi M, Rouprêt M, Truss M. Reporting and grading of complications after urologic surgical procedures: an ad hoc EAU guidelines panel assessment and recommendations. Eur Urol 2012; 61: 341–9.
Himal HS. Minimally invasive (laparoscopic) surgery. Surg Endosc 2002; 16: 1647–52.
Aning J, Gillatt D. When should patients with varicocele be referred? Practitioner 2012; 256: 17–20.
Schneck FX, Bellinger MF. Abnormalities of the testes and scrotum and their surgical management. In: Wein AJ, Kavoussi LR, Novick AC, Partin AW, Peters CA, editors. Campbell-Walsh Urology. 9th ed. Philadelphia, PA, USA: Saunders; 2007. pp. 3761–98.
Shamsa A, Mohammadi L, Abolbashari M, Shakeri MT, Shamsa S. Comparison of open and laparoscopic varicocelectomies in terms of operative time, sperm parameters, and complications. Urol J 2009; 6: 170–5.
Gerscovich EO. High-resolution ultrasonography in the diagnosis of scrotal pathology: I. Normal scrotum and benign disease. J Clin Ultrasound 1993; 21: 355–73.
Winkelbauer FW, Ammann ME, Karnel F, Lammer J. Doppler sonography of varicocele: long-term follow-up after venography and transcatheter sclerotherapy. J Ultrasound Med 1994; 13: 953–
Graif M, Hauser R, Hirshebein A, Botchan A, Kessler A, Yabetz H. Varicocele and the testicular-renal venous route: hemodynamic Doppler sonographic investigation. J Ultrasound Med 2000; 19: 627–31.
Demirci D, Gülmez I, Hakan NA, Ekmekçioglu O, Karacagil M. Comparison of extraperitoneoscopic and transperitoneoscopic techniques for the treatment of bilateral varicocele. J Endourol 2003; 17: 89–92.
Cobellis G, Mastroianni L, Cruccetti A, Amici G, Martino A. Retroperitoneoscopic varicocelectomy in children and adolescents. J Pediatr Surg 2005; 40: 846–9.
Cayan S, Kadioglu TC, Tefekli A, Dadioglu A, Tellaloglu S. Comparison of results and complications of high ligation surgery and microsurgical high inguinal varicocelectomy in the treatment of varicocele. Urology 2000; 55: 750–4.
Hirsch IH, Abdel-Meguid TA, Gomella LG. Postsurgical outcomes assessment following varicocele ligation: laparoscopic versus subinguinal approach. Urology 1998; 51: 810–5.
Pintus C, Rodriguez Matas MJ, Manzoni C, Nanni L, Perrelli L. Varicocele in pediatric patients: comparative assessment of different therapeutic approaches. Urology 2001; 57: 154–7.
Riccabona M, Oswald J, Koen M, Lusuardi L, Radmayr C, Bartsch G. Optimizing the operative treatment of boys with varicocele: sequential comparison of 4 techniques. J Urol 2003; 169: 666–8.
Pietrow PK, Weizer AZ, L’Esperance JO, Auge BK, Silverstein A, Cummings T, Preminger GM, Albala DM. PlasmaKinetic bipolar vessel sealing: burst pressures and thermal spread in an animal model. J Endourol 2005; 19: 107–10.
Newcomb WL, Hope WW, Schmelzer TM, Heath JJ, Norton HJ, Lincourt AE, Heniford BT, Iannitti DA. Comparison of blood vessel sealing among new electrosurgical and ultrasonic devices. Surg Endosc 2009; 23: 90–6.
Al-Kandari AM, Shabaan H, Ibrahim HM, Elshebiny YH, Shokeir AA. Comparison of outcomes of different varicocelectomy techniques: open inguinal, laparoscopic, and subinguinal microscopic varicocelectomy: a randomized clinical trial. Urology 2007; 69: 417–20.
Schwentner C, Oswald J, Lunacek A, Deibl M, Bartsch G, Radmayr C. Optimizing the outcome of microsurgical subinguinal varicocelectomy using isosulfan blue: a prospective randomized trial. J Urol 2006; 175: 1049–52.
Huk J, Fryczkowski M, Kaletka Z, Szwedkowski M. Comparison of testicular volume before and after laparoscopic varicocelectomy in children and adolescents. Med Wieku Rozwoj 2006; 10: 885–91.
Song T, Wang CY, Zhang L, Zhang F, Chen WZ, Fu WJ, Zhang X. Microscopic versus laparoscopic varicocelectomy in the treatment of varicocele: effects and complications. Zhonghua Nan Ke Xue 2012; 18: 335–8.
Sasagawa I, Yazawa H, Suzuki Y, Tateno T, Takahashi Y, Nakada T. Laparoscopic varicocelectomy in adolescents using an ultrasonically activated scalpel. Arch Androl 2000; 45: 91–4.
Simforoosh N, Ziaee SA, Behjati S, Beygi FM, Arianpoor A, Abdi H. Laparoscopic management of varicocele using bipolar cautery versus open high ligation technique: a randomized, clinical trial. J Laparoendosc Adv Surg Tech A 2007; 17: 743–7.
Sze DY, Kao JS, Frisoli JK, McCallum SW, Kennedy WA 2nd, Razavi MK. Persistent and recurrent postsurgical varicoceles: venographic anatomy and treatment with N-butyl cyanoacrylate embolization. J Vasc Interv Radiol 2008; 19: 539–45.
Richardson I, Grotas AB, Nagler HM. Outcomes of varicocelectomy treatment: an updated critical analysis. Urol Clin North Am 2008; 35: 191–209.
Riccabona M, Oswald J, Koen M, Lusuardi L, Radmayr C, Bartsch G. Optimizing the operative treatment of boys with varicocele: sequential comparison of 4 techniques. J Urol 2003; 169: 666–8.
Ding H, Tian J, Du W, Zhang L, Wang H, Wang Z. Open non-microsurgical, laparoscopic or open microsurgical varicocelectomy for male infertility: a meta-analysis of randomized controlled trials. BJU Int 2012; 110: 1536–42.