Needlescopic lymphatic-sparing varicocelectomy in children using a mediflex needle: a new simplified technique

Abstract

In this study we present a new technique for Needlescopic dye-assisted lymphatic-sparing Varicocelectomy (NV) in children using 14-gauge fascial closure needles (Mediflex ®, D-1001 New York, USA), (MedN) and a Vascular Access Canula (VAC). Forty-two male children with 55 varicoceles (13 bilateral, 29 unilateral) underwent NV. According to the Dubin grading system, nine varicoceles were grade II (16%) and 46 (84%) varicoceles were grade III. Testicular lymphatics were demarcated by injection of 2 ml methylene blue. Fifty-five needlescopic dye-assisted lymphatic-sparing varicocelectomy were performed on 42 male children. Patients’ age ranged between 8 and 16 years (mean 11.9 ± 3 years). The mean operative time was 32.6 ± 9.4 min for bilateral cases, and 21 ± 3.2 min for unilateral cases. All patients discharged home at the same day of surgery. There were no intraoperative complications. There was no conversion to either open or multiport laparoscopic technique. In cases of left varicocele, the median testicular volumes difference decreased from 0.2645 ± 0.17 preoperatively to 0.126 ± 0.08 post operatively (P < 0.001). In bilateral cases, the median testicular differences of right and left testicular volumes decreased from 0.074 ± 0.03 preoperatively, to 0.026 ± 0.02, postoperatively, and from 0.238 preoperatively ± 0.11, to 0.1125 ± 0.06, post operatively, (P < 0.05), respectively. Family satisfaction was achieved in 98% of cases. Excellent cosmetic appearance were obtained. This present method of single-port needlescopic dye-assisted varicocelectomy in children using MedN proved to be a feasible, safe, and an acceptable technique which further improves the cosmetic appearance and may be considered as an alternate minimally invasive varicocelectomy.