Abstract
BackgroundLaparo Endoscopic Single-site Surgery (LESS) represents an evolution of minimally invasive surgery and aims to improve cosmetic outcome and reduce surgical trauma and complications associated with traditional laparoscopy. This study was performed to present our preliminary experience in bilateral spermatic cord ligation with the LESS technique and compare the results with the outcomes of conventional laparoscopic surgery.MethodsBetween June 2007 and May 2013, 24 patients were referred to our institute for bilateral varicocelectomy. The indications for this type of procedure were bilateral varicocele with impairment of semen parameters or chronic bilateral testicular pain. All procedures were performed via the same surgeon. The patients were divided into two groups according to the type of laparoscopic surgery. Group A included 10 patients underwent LESS technique while group B included the remaining 14 patients that underwent conventional laparoscopy.ResultsThe comparison between the two techniques showed some important advantages for LESS: shorter operating time (45.4 min vs. 88.3 (P < .001), shorter hospital stay (16.6 hours vs. 51.4 hours) (P < .001), early return to the normal activity (2.3 days vs. 4.7 days) and better cosmetic outcomes. No conversions from LESS to conventional laparoscopy were necessary and blood loss was insignificant in all patients.All patients in the LESS group reported full satisfaction with the cosmetic outcome, whereas 85.7% of patients after conventional laparoscopy were fully satisfied with cosmesis.ConclusionsBilateral spermatic cord ligation with LESS is an alternative to conventional laparoscopy. The procedure was successfully performed in all patients. The trans-umbilical approach offers the advantage of a better cosmetic result, shorter hospital stay and less postoperative pain.
Highlights
Laparo Endoscopic Single-site Surgery (LESS) represents an evolution of minimally invasive surgery and aims to improve cosmetic outcome and reduce surgical trauma and complications associated with traditional laparoscopy
In this study we present our preliminary experience of bilateral en bloc spermatic cord ligation with LESS technique and compare the results with the outcomes of conventional laparoscopic surgery
All patients in the LESS group reported full satisfaction with the cosmetic outcome (Figure 5), whereas 85.7% of patients after conventional laparoscopy were fully satisfied with cosmesis
Summary
Laparo Endoscopic Single-site Surgery (LESS) represents an evolution of minimally invasive surgery and aims to improve cosmetic outcome and reduce surgical trauma and complications associated with traditional laparoscopy. This study was performed to present our preliminary experience in bilateral spermatic cord ligation with the LESS technique and compare the results with the outcomes of conventional laparoscopic surgery. There are several theories regarding the mechanism by which varicocele could inhibit the fertility potential of affected men. The most commonly proposed theory is that excess heat, due to the varicocele, reduces spermatogenesis. Various treatment modalities have been studied for patients with varicocele who have subfertility or scrotal pain, including percutaneous embolization, open (inguinal or high) varicocele ligation, subinguinal microsurgical varicocele ligation, and laparoscopic varicocele ligation. Advantages of laparoscopic varicocelectomy include: − increased magnification, facilitating more accurate identification of vessels [5,6]. Laparoscopic varicocelectomy allows for en bloc and bilateral ligation of the spermatic cord
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