Microsurgical Varicoceletomy : High Ligation with Preservation of the Lymphatic Vessels

概要

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Varicocelectomy is widely utilized for the treatment of male infertility arising from oligoasthenozoospermia. We describe a technique involving microsurgical high ligation characterized by lymphatic preservation and discuss the outcome. From March 2001 to February 2004, 226 infertility patients were evaluated, of which 45 were diagnosed with clinical varicocele. Twenty-three of these subjects underwent varicocelectomy. Under epidural anesthesia, a skin incision (approximately 3 cm in length) was generated 1 cm above the deep inguinal ring. Following dissection of the spermatic cord, the spermatic artery and vein were microsurgically ligated and cut with lymphatic sparing. All varicoceles disappeared; furthermore, scrotal hydrocele or testicular atrophy was not observed postoperatively. Sperm density and total motile sperm count increased markedly; however, motility was unchanged. Pregnancy and subsequent normal healthy delivery were attained in five subjects (21.7%). This approach consists of high ligation; consequently, preservation of the testicular artery is unnecessary. High ligation with microsurgical preservation of lymphatic vessels reduces risk of testicular atrophy resulting from arterial injury, prevents lymphatic hydrocele and de-emphasizes the level of microsurgical skill.
愛知医科大学の論文
2004-12-10