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Laparoscopic Techniques for Varicocele Repair

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Varicocele and Male Infertility

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Abstract

Varicocele is a relatively common disorder in children and adolescents that can impair spermatogenesis and may result in infertility. The incidence increases progressively from the age of 10 years and can be detected in at least 15% of all adolescent males. Varicocele is the most common correctable etiology found in adult men with infertility. The condition can often lead to testicular atrophy in prepubertal patients. Surgery is recommended in well-defined cases. The goal of all surgical methods of treating varicocele in children and adolescents is to improve the potential for future fertility. Success with diverse surgical procedures such as the Palomo retroperitoneal approach, Ivanissevich inguinal surgery, and the more recent antegrade sclerotherapy, retrograde embolization, microsurgical inguinal, and retroperitoneoscopic and laparoscopic procedures has been reported. Since the first description in 1988, the laparoscopic varicocele ligation procedure has become the most popular surgical method for treating this condition in children and adolescents; nevertheless, its application to adult patients is still controversial. The most frequent complication reported with the laparoscopic approach is the high rate of postoperative hydrocele, but this problem may be reduced with a dye-assisted spare of the lymphatics.

Author Contributions

R. Méndez-Gallart researched the data for the chapter and wrote the manuscript. M. García-Palacios contributed to the discussion of the chapter content and reviewed the manuscript before submission.

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References

  1. Jarow JP, Sharlip ID, Belker AM, Lipshultz LI, Sigman M, Thomas AJ, Schlegel PN, Howards SS, Nehra A, Damewood MD, Overstreet JW, Sadovsky R. Male Infertility Best Practice Policy Committee of the American Urological Association. J Urol. 2002;167:2138–44.

    Article  Google Scholar 

  2. Madgar I, Weissenberg R, Lunenfeld B, Karasik A, Goldwasser B. Controlled trial of high spermatic vein ligation for varicocele in infertile men. Fertil Steril. 1995;63:120–4.

    Article  CAS  Google Scholar 

  3. Gat Y, Zukerman Z, Bachar GN, Feldberg D, Gornish M. Adolescent varicocele: is it a unilateral disease? Urology. 2003;62:742–7.

    Article  Google Scholar 

  4. Dubin L, Amelar RD. Varicocele size and results of varicocelectomy in selected subfertile men with varicocele. Fertil Steril. 1970;21:606–9.

    Article  CAS  Google Scholar 

  5. Agarwal A, Hamada A, Esteves SC. Insight into oxidative stress in varicocele-associated male infertility: part 1. Nat Rev Urol. 2012;9(12):678–90.

    Article  Google Scholar 

  6. Yagi K. Simple procedure for specific assay of lipid hydroperoxides in serum or plasma. Methods Mol Biol. 1998;108:107–10.

    CAS  PubMed  Google Scholar 

  7. Nallella KP, et al. Relationship of interleukin6 with semen characteristics and oxidative stress in patients with varicocele. Urology. 2004;64:1010–3.

    Article  Google Scholar 

  8. Hendin BN, Kolettis PN, Sharma RK, Thomas AJ, Agarwal A. Varicocele is associated with elevated spermatozoal reactive oxygen species production and diminished seminal plasma antioxidant capacity. J Urol. 1999;161:1831–4.

    Article  CAS  Google Scholar 

  9. Sharma RK, Pasqualotto FF, Nelson DR, Thomas AJ, Agarwal A. The reactive oxygen species-total antioxidant capacity score is a new measure of oxidative stress to predict male infertility. Hum Reprod. 1999;14:2801–7.

    Article  CAS  Google Scholar 

  10. Pasqualotto FF, Sharma RK, Nelson DR, Thomas AJ, Agarwal A. Relationship between oxidative stress, semen characteristics, and clinical diagnosis in men undergoing infertility investigation. Fertil Steril. 2000;73:459–64.

    Article  CAS  Google Scholar 

  11. Pasqualotto FF, et al. Oxidative stress in normospermic men undergoing infertility evaluation. J Androl. 2001;22:316–22.

    CAS  PubMed  Google Scholar 

  12. Allamaneni SS, Naughton CK, Sharma RK, Thomas AJ, Agarwal A. Increased seminal reactive oxygen species levels in patients with varicoceles correlate with varicocele grade but not with testis size. Fertil Steril. 2004;82:1684–6.

    Article  Google Scholar 

  13. Smith R, et al. Increased sperm DNA damage in patients with varicocele: relationship with seminal oxidative stress. Hum Reprod. 2006;21:986–93.

    Article  CAS  Google Scholar 

  14. Cimador M, DiPace MR, Peritore M, Sergio M, Castagnetti M, De Grazia E. The role of Doppler ultrasonography in determining the proper surgical approach to the management of varicocele in children and adolescents. BJU Int. 2006;97:1291–7.

    Article  Google Scholar 

  15. Beutner S, May M, Hoschke B, Helke C, Lein M, Roigas J, et al. Treatment of varicocele with reference to age: a retrospective comparison of three minimally invasive procedures. Surg Endosc. 2007;21:61–5.

    Article  CAS  Google Scholar 

  16. Okuyama A, Nakamura M, Namiki M, Takeyama M, Utsunomiya M, Fujioka H, et al. Surgical repair of varicocele at puberty: preventive treatment for fertility improvement. J Urol. 1988;139:562–5.

    Article  CAS  Google Scholar 

  17. Jacobson DL, Johnson EK. Varicoceles in the pediatric and adolescent population: threat to future fertility? Fertil Steril. 2017;108(3):370–7.

    Article  Google Scholar 

  18. Brannigan RE. Introduction: varicoceles: a contemporary perspective. Fertil Steril. 2017;108(3):361–3.

    Article  Google Scholar 

  19. Will MA, Swain J, Fode M, Sonksen J, Christman GM, Ohl D. The great debate: varicocele treatment and impact on fertility. Fertil Steril. 2011;95(3):841–52.

    Article  Google Scholar 

  20. 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.

    Article  Google Scholar 

  21. 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.

    Article  Google Scholar 

  22. 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.

    Article  CAS  Google Scholar 

  23. Palomo A. Radical cure of varicocele by a new technique: preliminary report. J Urol. 1949;61:604–7.

    Article  CAS  Google Scholar 

  24. Jimenez-Garrido A, Garcia de la Torre MV, Sanchez de Badajoz E. A decade of laparoscopic varicocelectomy: costs and learning stages. Arch Esp Urol. 1999;52:245–8.

    CAS  PubMed  Google Scholar 

  25. Koyle MA, Oottamasathien S, Barqawi A, Rajimwale A, Furness PD 3rd. Laparoscopic Palomo varicocele ligation in children and adolescents: results of 103 cases. J Urol. 2004;172:1749–52.

    Article  Google Scholar 

  26. Franco I. Laparoscopic varicocelectomy in the adolescent male. Curr Urol Rep. 2004;5:132e6.

    Article  Google Scholar 

  27. Esposito C, Escolino M, Castagnetti M, Cerulo M, Settimi A, Cortese G, Turrà F, Iannazzone M, Izzo S, Servillo G. Two decades of experience with laparoscopic varicocele repair in children: standardizing the technique. J Pediatr Urol. 2018;14:10.e1–7.

    Article  Google Scholar 

  28. Al-Hunayan A, Abdulhalim H, Kehinde EO, El-Barky E, Al- Awadi K, Al-Ateeqi A. Two-trocar laparoscopic varicocelectomy: cost-reduction surgical technique. Urology. 2006;67:461–5.

    Article  Google Scholar 

  29. Link BA, Kruska JD, Wong C, Kropp BP. Two-trocar laparoscopic varicocelectomy: approach and outcomes. JSLS. 2006;10:151–4.

    PubMed  PubMed Central  Google Scholar 

  30. Valla JS. Retroperitoneoscopic surgery in children. Semin Pediatr Surg. 2007;16:270–7.

    Article  Google Scholar 

  31. Mancini S, Bulotta AL, Molinaro F, Ferrara F, Tommasino G, Messina M. Surgical retroperitoneoscopic and transperitoneoscopic access in varicocelectomy: duplex scan results in pediatric population. J Pediatr Urol. 2014;10:1037–42.

    Article  Google Scholar 

  32. Gaur DD, Agarwal DK, Purohit KC. Retroperitoneal laparoscopic varicocelectomy. J Urol. 1994;151:895–7.

    Article  CAS  Google Scholar 

  33. Zhang Z, Zheng SJ, Yu W, Han YF, Chen H, Chen Y, Dai YT. Comparison of surgical effect and postoperative patient experience between laparoendoscopic single-site and conventional laparoscopic varicocelectomy: a systematic review and meta-analysis. Asian J Androl. 2017;19(2):248–55.

    Article  Google Scholar 

  34. Zhang GX, Yang J, Long DZ, Liu M, Zou XF, Yuan YH, Xiao RH, Xue YJ, Zhong X, Liu QL, Liu FL, Jiang B, Xu RQ, Xie KL. Prospective randomized comparison of transumbilical two-port laparoscopic and conventional laparoscopic varicocele ligation. Asian J Androl. 2017;19(1):34–8.

    PubMed  Google Scholar 

  35. Choi H, Bae JH. Single port varicocelectomy using SILS™ multiple access port. Int Braz J Urol. 2015;41(2):395.

    Article  Google Scholar 

  36. Marte A, Pintozzi L, Cavaiuolo S, Parmeggiani P. Single-incision laparoscopic surgery and conventional laparoscopic treatment of varicocele in adolescents: comparison between two techniques. Afr J Paediatr Surg. 2014;11(3):201–5.

    Article  Google Scholar 

  37. Shu T, Taghechian S, Wang R. Initial experience with robot assisted varicocelectomy. Asian J Androl. 2008;10(1):146–8.

    Article  Google Scholar 

  38. Hidalgo-Tamola J, Sorensen MD, Bice JB, Lendvay TS. Pediatric robot-assisted laparoscopic varicocelectomy. J Endourol. 2009 Aug;23(8):1297–300.

    Article  Google Scholar 

  39. Méndez-Gallart R, Bautista Casasnovas A, Estévez Martínez E, Rodríguez-Barca P, Taboada Santomil P, Armas A, Pradillos J, Rivera L, Varela Cives R. Reactive hydrocele after laparoscopic Palomo varicocele ligation in pediatrics. Arch Esp Urol. 2010 Sep;63(7):532–6.

    Article  Google Scholar 

  40. Kocvara R, Dvorácek J, Sedlácek J, Díte Z, Novák K. Lymphatic sparing laparoscopic varicocelectomy: a microsurgical repair. J Urol. 2005;173(5):1751–4.

    Article  Google Scholar 

  41. Oswald J, Körner I, Riccabona M. The use of isosulphan blue to identify lymphatic vessels in high retroperitoneal ligation of adolescent varicocele--avoiding postoperative hydrocele. BJU Int. 2001;87:502–4.

    Article  CAS  Google Scholar 

  42. Esposito C, Iaquinto M, Escolino M, Cortese G, De Pascale T, Chiarenza F, Cerulo M, Settimi A. Technical standardization of laparoscopic lymphatic sparing varicocelectomy in children using isosulfan blue. J Pediatr Surg. 2014;49(4):660–3.

    Article  Google Scholar 

  43. Podkamenev VV, Stalmakhovich VN, Urkov PS, Solovjev AA, Iljin VP. Laparoscopic surgery for pediatric varicoceles: randomized controlled trial. J Pediatr Surg. 2002;37(5):727–9.

    Article  CAS  Google Scholar 

  44. Ishibashi H, Mori H, Yada K, et al. Indigo carmine dye-assisted lymphatic-sparing laparoscopic Palomo varicocelectomy in children. J Med Investig. 2014;61:151–5.

    Article  Google Scholar 

  45. Schwentner C, Radmayr C, Lunacek A, Gozzi C, Pinggera GM, Neururer R, et al. Laparoscopic varicocele ligation in children and adolescents using isosulphan blue: a prospective randomized trial. BJU Int. 2006;98:861–5.

    Article  Google Scholar 

  46. Rizkala E, Fishman A, Gitlin J, Zelkovic P, Franco I. Long term outcomes of lymphatic sparing laparoscopic varicocelectomy. J Pediatr Urol. 2013;9:458–63.

    Article  Google Scholar 

  47. Liang Z, Guo J, Zhang H, Yang C, Pu J, Mei H, Zheng L, Tong Q. Lymphatic sparing versus lymphatic non-sparing laparoscopic varicocelectomy in children and adolescents: a systematic review and meta-analysis. Eur J Pediatr Surg. 2011;21(3):147–53.

    Article  CAS  Google Scholar 

  48. Zampieri N, Corroppolo M, Zuin V, Cervellione RM, Ottolenghi A, Camoglio FS. Longitudinal study of semen quality in adolescents with varicocele: to treat or not? Urology. 2007;70(5):989–93.

    Article  Google Scholar 

  49. Goldstein M, Gilbert BR, Dicker AP, Dwosh J, Gnecco C. Microsurgical inguinal varicocelectomy with delivery of the testis: an artery and lymphatic sparing technique. J Urol. 1992;148:1808–11.

    Article  CAS  Google Scholar 

  50. Fast AM, Deibert CM, Van Batavia JP, Nees SN, Glassberg KI. Adolescent varicocelectomy: does artery sparing influence recurrence rate and/or catch-up growth? Andrology. 2014;2(2):159–64.

    Article  CAS  Google Scholar 

  51. Qi X, Wang K, Zhou G, Xu Z, Yu J, Zhang W. The role of testicular artery in laparoscopic varicocelectomy: a systematic review and meta-analysis. Int Urol Nephrol. 2016;48(6):955–65.

    Article  Google Scholar 

  52. Misseri R, Gershbein AB, Horowitz M, Glassberg KI. The adolescent varicocele. II: the incidence of hydrocele and delayed recurrent varicocele after varicocelectomy in a long-term follow-up. BJU Int. 2001;87:494–8.

    Article  CAS  Google Scholar 

  53. Méndez-Gallart R, Bautista-Casasnovas A, Estevez-Martínez E, Varela-Cives R. Laparoscopic Palomo varicocele surgery: lessons learned after 10 years' follow up of 156 consecutive pediatric patients. Pediatr Urol. 2009;5(2):126–31.

    Article  Google Scholar 

  54. Camoglio FS, Zampieri N. Varicocele treatment in paediatric age: relationship between type of vein reflux, surgical technique used and outcomes. Andrologia. 2016;48(4):389–92.

    Article  CAS  Google Scholar 

  55. Youssef T, Abdalla E. Single incision transumbilical laparoscopic varicocelectomy versus the conventional laparoscopic technique: a randomized clinical study. Int J Surg. 2015;18:178–83.

    Article  Google Scholar 

  56. McManus MC, Barqawi A, Meacham RB, Furness PD, Koyle MA. Laparoscopic varicocele ligation: are there advantages compared with the microscopic subinguinal approach. Urology. 2004;64(2):357–60.

    Article  Google Scholar 

  57. Pastuszak AW, Kumar V, Shah A, Roth DR. Diagnostic and management approaches to pediatric and adolescent varicocele: a survey of pediatric urologists. Urology. 2014;84(2):450–5.

    Article  Google Scholar 

  58. Parrilli A, Roberti A, Escolino M, Esposito C. Surgical approaches for varicocele in pediatric patient. Transl Pediatr. 2016;5(4):227–32.

    Article  Google Scholar 

  59. Hung JWS, Yam FSD, Chung KLY, Lau AKW, Leung YCL, Liu CCW, Tang PMY, Chao NSY, Leung MWY, Liu KKW. Comparison of scrotal antegrade sclerotherapy and laparoscopic Palomo surgery in treatment of adolescent varicocele: a 15-year review. J Pediatr Urol. 2018;14:534.e1.

    Article  Google Scholar 

  60. Esposito C, Monguzzi G, Gonzalez-Sabin MA, Rubino R, Montinaro L, Papparella A, et al. Results and complications of laparoscopic surgery for pediatric varicocele. J Pediatr Surg. 2001;36:767–9.

    Article  CAS  Google Scholar 

  61. Esposito C, Valla JS, Najmaldin A, Shier F, Mattioli G, Savanelli A, et al. Incidence and management of hydrocele following varicocele surgery in children. J Urol. 2004;171:1271–3.

    Article  Google Scholar 

  62. Hassan JM, Adams MC, Pope JC 4th, Demarco RT, Brock JW 3rd. Hydrocele formation following laparoscopic varicocelectomy. J Urol. 2006;175:1076–9.

    Article  Google Scholar 

  63. Johnson D, Sandlow J. Treatment of varicoceles: techniques and outcomes. Fertil Steril. 2017;108:378–84.

    Article  Google Scholar 

  64. Chan P. Management options of varicoceles. Indian J Urol. 2011;27:65–73.

    Article  Google Scholar 

  65. Glassberg KI. My indications for treatment of the adolescent varicocele (and why?). Transl Androl Urol. 2014;3:402–12.

    PubMed  PubMed Central  Google Scholar 

  66. Salem HK, Mostafa T. Preserved testicular artery at varicocele repair. Andrologia. 2009;41:241–5.

    Article  CAS  Google Scholar 

  67. Yamamoto M, Tsuji Y, Ohmura M, Hibi H, Miyake K. Comparison of artery-ligating and artery-preserving varicocelectomy: effect on post-operative spermatogenesis. Andrologia. 1995;27:37–40.

    Article  CAS  Google Scholar 

  68. Niyogi A, Singh S, Zaman A, Khan A, Nicoara C, Haddad M, Madden N, Clarke SA, Mathur A, Tsang T, Kulkarni M, Minocha A, DeCaluwé D. Varicocele surgery: 10 years of experience in two pediatric surgical centers. J Laparoendosc Adv Surg Tech A. 2012;22:521–5.

    Article  Google Scholar 

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Authors and Affiliations

  1. Pediatric Surgery & Urology, University Hospital of Santiago, Santiago de Compostela, A Coruña, Spain

    Roberto Mendez-Gallart

  2. Pediatric Surgery & Urology, University Hospital of Santiago, Santiago, Galicia, Spain

    Maria Garcia-Palacios

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  1. Roberto Mendez-Gallart
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  2. Maria Garcia-Palacios
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Correspondence to Roberto Mendez-Gallart .

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Editors and Affiliations

  1. ANDROFERT, Andrology & Human Reproduction Clinic, Campinas, São Paulo, Brazil

    Sandro C Esteves

  2. S.H. Ho Urology Centre, Department of Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, Hong Kong

    Chak-Lam Cho

  3. Department of Urology, Hamad Medical Corporation, Weill Cornell Medicine Qatar, Doha, Qatar

    Ahmad Majzoub

  4. Department of Urology, Cleveland Clinic, Cleveland, OH, USA

    Ashok Agarwal

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Mendez-Gallart, R., Garcia-Palacios, M. (2019). Laparoscopic Techniques for Varicocele Repair. In: Esteves, S., Cho, CL., Majzoub, A., Agarwal, A. (eds) Varicocele and Male Infertility. Springer, Cham. https://doi.org/10.1007/978-3-319-79102-9_18

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  • DOI: https://doi.org/10.1007/978-3-319-79102-9_18

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