Repair of testicular artery injury during microsurgical varicocelectomy.

Abstract

Among the various techniques of performing varicocelectomy microsurgical ligation using an operating microscope has been shown to be effective and is associated with minimal morbidity.1, 2 In particular testicular artery injury, which has the potential to cause testicular atrophy, is rarely seen with this approach. We have performed more than 100 such procedures in the last 3 years and have encountered this complication in 1 patient. In this case the microsurgical approach allowed immediate identification and successful simultaneous repair of the vessel. CASE REPORT A 30-year-old patient with primary infertility with oligoasthenospermia presented for repair of a grade 2 varicocele in the left testis. Microsurgical varicocelectomy was performed through a subinguinal approach with the patient under general anesthesia. After division of the spermatic fascia a large vein was identified, with the testicular artery observed adhering to the undersurface. The vein was gently separated from the artery for a distance of about 3 mm. and ligated at 2 ends with a silk suture. After division of the vein a tear was noted in the anterior wall of the artery with spurting blood. The 2 ligatures on the vein were not divided and, instead, were used to pull the ends of the vein and the underlying artery upward and laterally to obtain hemostasis (fig. 1). The arterial lumen was flushed with heparinized saline and the tear was closed with 3, 11-zero nylon sutures. Traction was relieved and the ligatures were divided. Distal pulsation of the artery was confirmed and the procedure was completed. Followup at 2 weeks revealed a normal testis, and Doppler evaluation confirmed flow in the testicular artery (fig. 2).