Lymphatic Sparing Microscopic Retroperitoneal Varicocelectomy: A Preliminary Experience

Abstract

One of the most common approaches to varicocele in adolescents is the Palomo technique. We report the experience of a single surgeon using a modification in which an operating microscope was brought into the field so that lymphatics were identified and preserved. By sparing lymphatics we attempted to reduce the hydrocele rate to levels achieved with microscopic inguinal and subinguinal surgery. A total of 20 boys with grade III varicocele underwent retroperitoneal gonadal vessel ligation with microscope assisted sparing of lymphatics between November 2004 and June 2007. Mean patient age was 15 years and mean followup was 11.2 months (range 1 to 29). Microscopic retroperitoneal varicocelectomy was performed in all patients with sparing of lymphatics under high power microscope. Clinical examination was performed at 1 week, 3, 6 and 12 months, and then annually to assess for recurrence and hydrocele. All boys who were followed had no hydrocele or recurrence. The microscope has had a large role in inguinal and subinguinal approaches. However, this technique takes up to 2 hours and testicular atrophy has been reported. There were no complications and operative time was shorter. Our technique, which uses magnification in the retroperitoneum, has not been described previously. It combines the simplicity of the original Palomo technique with a short period of microscopic dissection for identification and sparing of the lymphatics. This modification results in high success rates and fewer postoperative hydroceles.