121 3D Video Assisted Telescopic Microsurgical Subinguinal Varicocelectomy

Abstract

Varicocele is one of the most common physical findings in subfertile men. Microsurgical subinguinal approach for varicocelectomy procedure is a recommended surgical technique. Recently, a new technology called 3D video-assisted telescope operating monitor has been used in microsurgery. This video illustrates our technique of 3D video-assisted telescopic microsurgical subinguinal varicocelectomy. 4 varicocelectomy procedures were performed in 3 men in July 2017. The 3D video-assisted telescope operating monitor platform (KARL STORZ GmbH & Co, Tuttlingen, Germany) was utilized. Testicular arteries were identified by using an audible microdoppler probe (VTI, Vascular Technology Inc, Nashua NH). Semen analysis and scrotal ultrasound imaging were obtained preoperatively from all patients. Median operative duration (3D video-assisted telescopic microsurgical portion) per side was 20 min (15-25). Indications for the procedure were presence of a clinical grade 2 or 3 varicocele and the following conditions: oligoospermia in 1 patient and chronic testicular pain in 2 patients. Median follow-up was 3 months. There was no difference in sperm parameters of the patient who had oligoospermia but both of the testicular pain patients had a significant reduction in pain at three months post-operatively. The use of the 3D video-assisted telescope operating monitor platform improved surgical efficiency with up to 40x magnification. The 3D platform offered a great depth of field so that the entire surgical site was brought into clear focus and frequent refocusing is avoided.