Ligation Of Spermatic Vein Research Articles

Comparison of the use of remifentanil in infusion and patient-controlled methods for sedation purposes

Aims: In this study, the infusion and patient-controlled with PCA device use of remifentanil used for sedation were compared in patients who were planned to undergo spermatic vein ligation under local anesthesia. Methods: Thirty patient between the ages of 15-45 who were in the ASA I-II group were included in the study. They were randomly divided into 3 groups: continuous infusion (Group I), patient-controlled sedation (Group P) and control group (Group C). All patients were premedicated with 0.07 mg/kg midazolam intravenously (IV). 0.1 µg/kg/min remifentanil was given to Group I, 0.5 µg/kg bolus remifentanil was given to Group P, and physiological saline was given to Group C via a PCA (patient-controlled analgesia) device. The patients' hemodynamic parameters, sedation levels, anxiety scores, drug consumption amounts, patient satisfaction and side effects were recorded in the intraoperative and postoperative periods. During the operation, 2-3 L/min oxygen was administered via mask to patients whose SpO2 fell below 93%. Results: Respiratory depression was more common in Group I but respiratory rate did not fall below 8 in any group. In Group I, 7 patient, in Group P, 4 patient required intraoperative oxygen. The total amount of drug consumed was 64.4 µg in Group P and 147.5 µg in Group I. Although the number of PCA requests was not different, 4 patients in Group I, 2 patients in Group P and 1 patient in Group C never pressed the device. In terms of patient satisfaction, 30% of the patients in Group I said it was excellent, while in Group C it was not evaluated as perfect. The number of patients who evaluated the method as excellent and very good was higher in Group P than Group I. Conclusion: Remifentanil sedation with a PCA device can be used safely compared to infusion in patients undergoing spermatic vein ligation under local anesthesia.

Microscopic internal spermatic-inferior epigastric vein anastomosis for treating left varicocele.

To evaluate the clinical efficacy of microscopic internal spermatic-inferior epigastric vein anastomosis in the treatment of left varicocele and compare it with microscopic spermatic vein ligation for the same condition. A retrospective analysis of 74 patients with left varicocele between July 2020 and July 2022 was performed. The patients were divided into two groups based on the surgical method used. Group A consisted of 37 patients who underwent microscopic internal spermatic-inferior epigastric vein anastomosis, while Group B consisted of 37 patients who underwent microscopic spermatic vein ligation. Comparison of preoperative and postoperative semen quality, reproductive hormone levels, scrotal ultrasound results, duration of surgery, length of hospital stay, postoperative recurrence rate, and occurrence of complications with a follow-up time of 12 mo between two groups. Both groups showed significant improvements in semen quality and serum reproductive hormone levels. The Group A demonstrated significantly improved sperm forward motility compared to Group B, but had longer operation times and hospital stays (P < 0.05). After 1 year of follow-up, 8 partners in Group A and 6 partners in Group B achieved natural conception, with no significant difference between the two groups. There were no recurrences observed in either group during the follow-up period, and no significant statistical differences were found in other postoperative observation indicators. Both microscopic internal spermatic-inferior epigastric vein anastomosis and microscopic spermatic vein ligation are effective surgical methods for treating left varicocele. Anastomosis surgery provides greater improvement in sperm motility, although it is associated with longer operation times and hospital stays.

This Month in Adult Urology.

This Month in Adult Urology.

Elastography and contrast-enhanced ultrasound to assess the effect of varicocelectomy: A case-controlled study.

To evaluate the changes in testicular stiffness and microcirculation caused by spermatic vein ligation in patients with varicocele, we conducted a case-controlled study. A total of 27 grade III left varicocele cases were enrolled. Testicular stiffness and perfusion were evaluated by shear wave elastography and contrast-enhanced ultrasound during subinguinal microscopic varicocelectomy. The external and the internal parenchyma of bilateral testes were selected to compare the shear wave velocity of bilateral testes during the spermatic vein ligation. We mapped and compared the intensity-time curves following bolus contrast injection three times in the same region of interest. Initially, the shear wave velocity of the left internal parenchyma was higher than the right side (1.10 ± 0.06 m/s vs. 1.00 ± 0.03 m/s). It decreased (1.09 ± 0.06 m/s) (p < 0.05) after ligation. Meanwhile, the left epididymis had the higher agent peak intensity (0.90 × 10E-5AU), the largest area under the curve (80.20 × 10E-5AU s), and the longest washout area (54.35 × 10E-5AU s). In addition, the left internal parenchyma presented a sharper slope (0.18 × 10E-5AU/s) (p < 0.05). In conclusion, the spermatic vein ligation improved the perfusion of the internal testicular parenchyma, but it could temporally deteriorate the stasis of the epididymis. These changes caused softer testicular parenchyma.

The Application Effect of Jiawei Sanyu Shengjing Decoction Combined with High Ligation of the Spermatic Vein in Varicocele Male Infertility Patients.

Objective To analyze the application effect of Jiawei Sanyu Shengjing decoction combined with high ligation of the internal spermatic vein in male infertility patients with varicocele (VC). Methods 106 male infertility patients with VC treated in our hospital from December 2018 to March 2019 were selected as examples. According to the length of stay, they were divided into the control group and observation group, with 53 cases in each group. High ligation of the internal spermatic vein was performed in both groups. On this basis, the observation group was treated with modified Sanyu Shengjing decoction, and the therapeutic effects of the two groups were compared. Results The effective rate of 94.34% in the observation group was higher than 79.25% in the control group (P < 0.05). After treatment, the serum index level and sperm deformity rate in the observation group were lower than those in the control group, and the semen density and sperm activity were higher than those in the control group (P < 0.05). Conclusion The treatment of VC male infertility with modified Sanyu Shengjing decoction combined with high ligation of the internal spermatic vein can effectively improve the number of sperm and reduce the density of semen.

Modern approaches to the surgical treatment of varicocele in childhood

In the structure of male infertility, varicocele is being detected in 30–40 % cases of primary infertility, and in 80 % cases of secondary infertility. At the age of 10 years during the screening, only 1 % of boys have a varicocele, but in the pubertal period this figure increases to 15–20 %. Indications for surgery in childhood differ from those in adults, since grade III varicocele must be associated with ipsilateral testicular atrophy more than 20 % compared to contralateral, or combined with pain. Surgical methods of varicocele treatment are different. Discussions are ongoing regarding the choice of ligation of the internal spermatic vein. There is no general agreement on the technique of surgical intervention. There are about 100 different methods of internal spermatic vein ligation in the world, the most popular of which are the retroperitoneal approach according to Palomo, transinguinal access according to Ivanissevich, subinguinal ligation according to Marmar, vascular embolization and laparoscopic suprainguinal approach. Currently, there is no gold standard for surgical treatment of varicocele in pediatric surgery in contrast to adulthood, where microsurgical subinguinal varicocelectomy has already become a classic method of intervention. This is due to a lower complication rate compared to high ligation. Subinguinal varicocelectomy can sometimes lead to testicular atrophy due to damage to the testicular artery, which is difficult to visualize during surgery. In childhood, Marmar operation is complicated by the small size of the spermatic cord structures, which requires the search for new methods of intraoperative visualization of vascular structures. In this article, intratesticular injection of 1% methylene blue was used for lymphatic vascular contrast and indirect visualization of the testicular artery, which allows for the use of subinguinal varicocelectomy in adolescents.

EFFECT OF MICROSURGICAL VARICOCELECTOMY ON NONOBSTRUCTIVE AZOOSPERMIA (NOA) AND SEVERELY OLIGOZOOSPERMIA

Varicoceles are the most frequent physical abnormality found in infertile men and surgical ligation of spermatic vein is generally accepted as the treatment of choice for this condition. The aim of this study is to assess the treatment outcome and the benefits after microsurgical varicocelectomy in men with nonobstructive azoospermia (NOA) and severely oligozoospermia. Retrospective clinical analysis. The records were retrospectively evaluated for 41 patients with NOA and 259 severely oligozoospermic patients who underwent microsurgical inguinal varicocele ligation. The age was 34.34.3 (meanSD) years. Two hundred sixty-nine (90%) underwent a unilateral left-sided procedure (33 of 41 with NOA, 236 of 259 with severe oligospermia), and 31 (10%) underwent a bilateral procedure. Severely oligozoospermia was defined as <5x106/ml in all analyses submitted. Our indication of varicocelectomy for NOA patients was more than 12 ml of testicular volume preoperatively and the palpable varicocele. We obtained institutional review board approval as well as individual patient signed consents. Chi-square test was used to compare continuous variables between the groups. In all cases, statistical significance was set at P <0.05. ± After ligation, induction of spermatogenesis was achieved in six men (14.6%). We could not find the predictive factor retrospectively (e.g. hormone levels or testicular volume). The sperm concentration increased from 2.71.4 to 12.16.5 million/mL (P<0.001) with severely oligozoospermic patients. The sperm motility did not change significantly. Twenty seven (10.4%) of the 259 oligospermia men have contributed to unassisted pregnancies. Among 259 patients with severely oligozoospermia, improvement of sperm concentration was seen in 152 patients (responders, 59%). Between responders and non-responders with severely oligozoospermia, no significant differences were seen in FSH level (9.25.5 and 10.44.9 IU/L, respectively), LH level (4.72.2 and 5.13.5 IU/L, respectively), testosterone level (4.32.2 and 4.52.4 ng/mL, respectively), left testicular volume (15.63.3 and 16.13.4 mL, respectively), the percentage of varicocele grade III (52 and 54 %, respectively), and the volume of semen (2.80.7 and 2.91.2 mL, respectively). Microsurgical varicocelectomy resulted in the induction or enhancement of spermatogenesis for several men with NOA or severely oligozoospermia. It is reasonable to be considered an option in selective patients with NOA before testicular sperm extraction and severely oligozoospermia.

Blood flow condition in the left renal vein in operative treatment of patients with varicocele

The purpose of the study was to evaluate the blood flow in the left renal vein after ligation of the internal spermatic vein with varicocele and to study the changing of the level of biological markers of acute kidney damage in these patients.&#x0D; Materials and methods. Under observation were 64 men in age 1823 years with the first hemodynamic type of varicocele. In 3 patients clinically significant compression of the left renal vein was revealed and the remaining 61 patients underwent surgery by Ivanissevich approach. Before the operation, on the 2nd, 10th, 30th and 90th days after the operation patients underwent Doppler blood flow rate by ultrasound with color mapping of the left renal vein with measurement of venous blood flow velocity. During these periods all patients underwent laboratory tests, including the study of the content of cystatin C and interleukin 18 in the blood and urine.&#x0D; Results. On the first day after ligation of the internal spermatic vein an increase in the concentration of biological markers of acute kidney damage in the blood and urine was noted. After surgery all patients showed an increase in the diameter of the left renal vein by 1.52 mm and a decrease in the linear blood flow velocity in the region of the renal vien by 56 cm/s. On the 10th day after the operation the diameter of the left renal vein was increasesd by 34 mm more and the linear blood flow velocity slows down by 22.5 cm/s. The restoration of blood flow velocity and the diameter of the left renal vein occurred within three months and in most cases returned to baseline and in 22.9% of patients recovery did not occur by the 90th day of observation.&#x0D; Conclusion. Ligation of the internal spermatic vein with varicocele is accompanied by impaired blood flow in the left renal vein and an increase in the concentration of biological markers of acute kidney damage, which is a manifestation of venous hypertension and renal hypoxia. In most patients these indicators normalize to the 90th day of observation after surgery.

Microscopical spermatic vein ligation combined with shaofu zhuyu decoction for the treatment of varicocele caused by sthenospermia

Objective To investigate the clinical effect of varicocele(VC) induced oligospermia treated by arterial microvascularization combined with shaofu zhuyu decoction. Methods From March 2016 to October 2018, 50 cases of VC infertility patients were seleced and randomly divided into treatment group and the control group(n=25), the treatment group were given by microscopic spermatic vein ligation combined lower abdomen stasis soup, one dose a day, morning and evening for three months. In the control group, only microscopical spermatic vein ligation was performed. Results All the patients were successfully operated, the postoperative symptoms disappeared, the sperm concentration, semen volume and sperm activity were significantly increased, and the percentage of abnormal sperm was significantly decreased, the difference was statistically significant(P<0.05). The semen parameters of the patients in the treatment group with shaofu zhuyu decoction improved significantly after 3 months, there was significantly better than the control group. Conclusions Microscopical spermatic vein ligation combined with shaofu zhuyu decoction for the treatment of asthenospermia caused by varicocele has a satisfactory effect and the semen quality has been improved obviously. Key words: Varicocele; Asthenozoospermia; Ligation; CHINESE PATENT DRUGS

Comparison of curative effect of different surgical methods on varicocele

Objective To compare the curative effect of three different surgical methods: peritoneal varicocele ligation, peritoneal single-port laparoscopy and microscopy on varicocele. Methods Retrospective analysis of the case data of 150 patients with varicocele treated in the Affiliated Hospital of Xuzhou Medical University from September 2016 to September 2018. The average age was 24.5 years, and the age range was 22-30 years. The patients were divided into three groups according to different surgical methods: open group, laparoscopy group and microscope group, with 50 cases in each group. Patients in the open group were treated with retroperitoneal spermatic cord ligation. Patients in the laparoscopic group were treated with single-hole laparoscopic laparoscopic surgery. Patients in the microscope group were treated with microscope surgery. Operation time, postoperative hospitalization time, hospitalization cost reserved arteries, surgical complications (such as testicular hydrocele, scrotal edema, epididymitis, testicular atrophy), recurrence, and semen quality improvement were compared between three groups. Measurement data were expressed as mean ± standard deviation(Mean±SD), the two comparisons used the t test, the comparison between the three groups used the analysis of variance, and the comparison between the count data groups using the Chi-square test. Results The operation time of the patients in the microscope group [(52.52 ± 4.29) min] was longer than that of the open group [(36.60±3.69) min] and the laparoscopic group [(39.54±2.87) min]. The difference between the two groups was statistically significant (P<0.05); but the postoperative hospitalization time and hospitalization cost of patients in the microscope group [(2.16±0.95) d, (5 251 ± 300) yuan] were higher than those in the open group [(3.80±0.78) d, (64 75±415) yuan)]and the laparoscopic group [(3.28±1.01)d, (7 379±273) yuan] . The results of pairwise comparison showed that the difference between the microscope group, the open group and the laparoscopic group was statistically significant (P<0.05). Arterial preservation in the microscope group [47(94.0%)] were compared with the open group [35 (70.0%)], and laparoscopic group [30(60.0%)] had obvious advantages. Pairwise comparison results showed that the comparison between the microscope group and the open group and the laparoscopic group was statistically significant (P<0.05). After follow-up for six months, 2 cases were lost to follow-up in the microscope group, 1 cases were lost to the open group, and 5 case was lost to the unilateral laparoscopic group. 2(4.2%) patients had complications in the microscope group, and 14 (28.6%) patients had complications in the open group; 9 (20.0%) patients had complications in the laparoscopic group, and the total incidence of complications showed a pairwise comparison, the difference between the microscope group, the open group and the laparoscopic group was significant (P<0.05). The recurrence rate in the microscope group was 2.1% (1/48), the recurrence rate in the open group was 18.4% (9/49), and the recurrence rate in the laparoscopic group was 13.3% (6/45); the recurrence rate was compared in pairs, the difference between the microscope group, the open group and the laparoscopic group was significant (P<0.05) . The improvement rate of semen quality in the microscope group was 68.8% (33/48), the open group was 42.9%(21/49), the laparoscopic group was 55.6%(25/45), pairwise comparison results showed that the microscope group compared with the open group and laparoscopy group, the difference were statistically significant (P<0.05). Conclusions Microscopic surgery has less trauma, faster postoperative recovery, shorter operation cost and hospitalization time. Postoperative complications and recurrence, and improved semen quality are all superior to open spermatic vein ligation and single-hole umbilical laparoscopic surgery, it is a safe and effective way to treat varicocele. Key words: Varicocele; Laparoscopes; Microscopy; High varicocele ligation; Comparative effectiveness research

Observation on the efficacy of laparoscopic high ligation of spermatic vein combined with compound xuanju capsule in the treatment of infertility caused by varicocele

Objective To observe the efficacy of laparoscopic high ligation of spermatic vein combined with compound xuanju capsule in treating infertility caused by varicocele. Methods Retrospective analysis of 49 cases of infertility caused by varicocele admitted to the Affiliated Hospital Xuzhou Medical University from February 2015 to November 2016, average age was 27.5 years, aged 20-50 years; according to simple random method divided into experimental group (n=20) and control group (n=29). Patients in the experimental group were treated with laparoscopic high ligation of spermatic vein and compound xuanju capsule. Patients in the control group were treated with high ligation of spermatic vein. Semen quality (sperm concentration, forward motor sperm rate, sperm survival rate), peripheral blood sex hormone (follicle stimulating hormone, luteinizing hormone testosterone) were compared between the two groups before and 3 months after surgery. Pregnancy rate of the spouse 1 year after surgery were compared between the two groups. Measurement data were expressed as mean± standard deviation (Mean±SD), and t-test was used for comparison between groups; count data were compared by Chi-square test. Results Preoperative sperm concentration [(14.95±2.35) million/ml vs (15.69±3.35) million/ml, P=0.118], forward motor sperm rate [(24.35±3.72)% vs (25.10±3.89)%, P=0.221], sperm survival rate [(27.90±2.59)% vs (26.93±3.20)%, P=0.122]was not statistically significant between experimental group and control group. 3 months after operation, sperm concentration [(23.45±4.39) million/ml vs (20.07±2.91) million/ml, P=0.001], forward motor sperm rate [(34.80±3.56)% vs (31.62±3.75)%, P=0.001], sperm survival rate [(44.55±4.29)% vs (39.52±4.49)%, P=0.001] was statistically significant between experimental group and control group. Preoperative follicle stimulating hormone [(8.97±0.64) IU/L vs (9.17±0.96) IU/L, P=0.238] and luteinizing hormone [(6.75±0.49) IU/L vs (6.64±0.37) IU/L, P=0.744], testosterone [(10.87±1.66) nmol/L vs (9.98±1.17) nmol/L, P=0.064] was not statistical significance between experimental group and control group. 3 months after operation, Follicle stimulation. [(6.96±0.66) IU/L vs (7.34±0.77) IU/L, P=0.043], luteinizing hormone [(6.04±0.39) IU/L vs (6.15±0.38) IU/L, P=0.038], testosterone [(14.46±1.30) nmol/L vs (12.23±2.23) nmol/L, P=0.001] was statistically significant between experimental group and control group. Pregnancy rate of the spouse 1 year of the experimental group was higher than the control group [65.0% (13/20) vs 48.3% (14/29)], but it was not statistically significant between two groups (χ2=1.34, P=0.247). Conclusions Laparoscopic high ligation of spermatic vein combined with compound Xuanju capsule in the treatment of infertility caused by varicocele can significantly improve semen quality and sex hormone levels. From visual data, the natural pregnancy rate is also improved compared with the simple operation group. It is worthy of clinical recommendation. Key words: Varicocele; Laparoscopes; High ligation of spermatic vein; Compound xuanju capsule; Infertility

Ultrasound-assisted microsurgical left spermatic-inferior epigastric vein anastomosis for treating nutcracker syndrome-associated varicocele.

The study summarizes the effectiveness of ultrasound-assisted microsurgical left spermatic-inferior epigastric vein anastomosis for treating nutcracker syndrome (NCS)-associated varicocele. Cases of NCS-associated varicocele were recruited between December 2012 and December 2018. Prior to the operation, all patients were tested for the internal diameter and blood flow velocity of left renal vein, testicular volume, maximum venous diameter and venous retrograde flow in the pampiniform plexus of veins during the Valsalva maneuver by Color Doppler ultrasound. Moreover, the direction of left spermatic and inferior epigastric vein was marked. All patients underwent ligation of the internal spermatic veins and left spermatic-inferior epigastric vein anastomosis under microscopy. Color Doppler ultrasound, urinary and semen analysis (above age 18years old) were reviewed during the follow-up period. 53 patients (94.6%) underwent spermatic-inferior epigastric vein anastomosis with the mean operation time of 78.4 ± 14.2min. The hospital stay was 4-7days. Scrotal hydrocele, wound infection and testicular atrophy did not occur after operation. However, there were 5 cases of left varicocele recurrence and 2 cases of vascular anastomotic thrombosis. 51 cases had decrease in blood peak flow rate of left renal vein and improvement in nutcracker syndrome while scrotal bulge symptoms resolved in 26 cases. 10 cases had microscopic hematuria disappearance with symptom improvement in 2 cases. 19 cases of left testicular hypotrophy experience no further deterioration after surgery, of which 16 cases had catch-up testicular growth. Ultrasound-assisted microsurgical left spermatic-inferior epigastric vein anastomosis assisted is safe, easy and effective for treating nutcracker syndrome-associated varicocele.

Effect of ligation of lead vein on microscopic ligation of spermatic vein

Effect of ligation of lead vein on microscopic ligation of spermatic vein

Treatment of left varicocele by microsurgical external ligation of spermatic vein in 105 cases

Objective To investigate the efficacy of microsurgical subinguinal varicocelectomy for unilateral varicocele. Methods One hundred and five cases with left side varicocele were enrolled from August 2012 to October 2016.Thirty one cases suffered from varicocele in Ⅱ degree, and other seventy four cases in Ⅲ degree. Clinical data including operation time, sperm quality, testosterone level, complications and natural pregnoncy rate were retrospectively analyzed. The measurement data were expressed by ±s. Sperm concentration, sperm motility, the rate of sperm normal morphology and serum testosterone levels were compared before and after operation with paired t test. Results The average operative time of varicocele was (58±9) minutes in the outer ring of the microscope. Compared with preoperation′s, sperm concentration, sperm motility, the rate of sperm normal morphology was remarkable improved after 3 month. However, serum testosterone levels were steady. In the outpatient follow-up, there were no complications, such as orchiatrophy, hydrocele of tunica vaginalis or recurrence of varicocele. The rate of natural pregnoncy in one year was 46.7%. Conclusions Microsurgical subinguinal varicocelectomy can remarkably improve sperm quality for patients, who suffer from varicocele in Ⅱor Ⅲ degree. The complication of microsurgical subinguinal varicocelectomy is rare. Male infertility patients resulted from varicocele will get favorable natural pregnoncy rate. Key words: Varicocele; Infertility; Microsurgery

Treatment of varicocele combined with asthenospermia by microsurgical shunt: 3 cases report

To investigate the clinic value of microsurgical shunt for the treatment of varicocele combined with asthenspermia, the clinical data and therapeutic method for 3 patients, who conducted the microscope spermatic vein high ligation combined with superficial epigastric vein flow, were retrospectively analyzed. No postoperative complications were found, and the original symptoms and signs were disappeared. All patients were conducted scrotal ultrasound and semen routine after 3 months, and all indexes, including maximum internal diameter of the cord vein (erect position), sperm density, sperm survival rate, sperm deformity rate and sperm forward movement rate, were gradually improved. Consequently, high ligation of spermatic vein combined with vascular bypass surgery under the microscope can block the countercurrent venous blood and establish a new return channel to the testis. Meanwhile, it can also protect the testicular artery and lymph-vessel. It is worth to be spread for the treatment of varicocele combined with asthenospermia.

Efficacy and safety of 0.75% ropivacaine instillation into subinguinal wound in patients after bilateral microsurgical varicocelectomy: a bi-center, randomized, double-blind, placebo-controlled trial.

ObjectiveTo evaluate the efficacy and safety of 0.75% ropivacaine instillation into inguinal wound in patients who have undergone bilateral microsurgical varicocelectomy.Patients and methodsEighty-five men who were screened for bilateral varicoceles from March 2015 to July 2016 were randomized for the treatment. All patients underwent inguinal varicocelectomy by general anesthesia. After ligation of the internal spermatic veins from the spermatic cord, additional delivery of testis through inguinal incision site was done to ligate external spermatic veins and gubernacular veins. Before repairing external oblique aponeurosis, 6 mL of 0.75% ropivacaine and 6 mL of normal saline were instilled under the fascia and around the funiculus (spermatic cord) by a randomized and double-blind method. Visual analog scale (VAS) pain score and Prince Henry Pain Score (PHPS) were used for evaluating operative sites at 1, 2, 4, and 8 hours and 7 days after surgery. Safety and tolerability were evaluated throughout the course of this study by assessing adverse events.ResultsA total of 55 men completed the study. Of these 55 men, 31 received instillation of ropivacaine on the left operative site, while 24 received instillation of ropivacaine on the right operative site. VAS pain scores and PHPS in the ropivacaine-instilled operative site were significantly lower compared to those obtained with placebo at 2, 4, and 8 hours after surgery. In general, instillation of ropivacaine was safe and well tolerated in patients.ConclusionRopivacaine instillation into inguinal surgical site wound significantly reduced postoperative pain after microsurgical varicocelectomy.

Treatment effect of TUSPLV on recurrent varicocele.

The aim of the study was to analyze the treatment effect of transumbilical single-port laparoscopic varicocelectomy (TUSPLV) on recurrent varicocele (VC). In order to compare the surgical effects of TUSPLV to traditional retroperitoneal ligation of the internal spermatic vein, 64 patients with recurrent VC were enrolled and divided into the control group (n=30) and the observation group (n=34). Patients in the control group underwent surgery using traditional retroperitoneal ligation of the internal spermatic vein, while those in the observation group underwent surgery using TUSPLV. The results showed that the time of operation and bleeding volume in the observation group were significantly lower. The occurrence and recurrence rates of periprocedural complications were considerably lower in the observation group. Differences were statistically significant (P<0.05). In terms of the pregnancy rate, the difference between the 2 groups had no statistical significance (P>0.05). We concluded that employing TUSPLV to treat recurrent VC was safe and effective.

Transumbilical Single-Incision Laparoscopic Surgery in Children with Conventional Instruments: Our Early Experience.

Laparoscopic surgery is the current accepted approach in most pediatric surgical centers. In an attempt to further minimize the surgical trauma and improve cosmetic outcome, new techniques with a single incision through the umbilicus have been proposed and we believe they will become the standard choices for pediatric surgery. This report describes our initial experience with transumbilical single-incision laparoscopic surgery (TSILS) in children with conventional instruments. A retrospective review of 82 pediatric patients who underwent TSILS in children with conventional instruments from January 2011 to June 2015 was performed. The operations included 56 appendectomies, 9 cholecystectomies, and 17 spermatic vein ligations. The average age by procedure was 6.2 years for appendectomy (range of 3-14 years); 12.4 years for cholecystectomy (range of 10-14 years); and 12.8 years for spermatic vein ligation (range of 11-14 years). The average operative time was 32 minutes for appendectomy (range of 25-56 minutes); 54 minutes for cholecystectomy (range of 35-95 minutes); and 23 minutes for spermatic vein ligation (range of 17-41 minutes). The average length of staying in hospital was 3 days (range of 2-5 days). All of the operations in 82 cases were successful. None required conversion to open or conventional laparoscopic surgery. There was no obvious wound pain. In addition, there were no wound infections on umbilicus and any other intraoperative complications. There was no obvious scar at patients' umbilicus after postoperative follow-up for 2-4 weeks. TSILS is a safe and viable technique that may be used successfully in pediatric surgery. Additionally, excellent cosmetic results are obtained as evidenced by imperceptible umbilical scarring.

Expression and significance of miR-210 in the epididymis in rats with varicocele and following varicocelectomy

Objective: To investigate the expression of microRNA 210 (miR-210) in the epididymis of rats with varicocele and changes in miR-210 expression following high spermatic vein ligation, so as to explore the significance of the surgery in treating varicocele. Methods: A total of 21 male Sprague-Dawley (SD) rats aged 7 weeks were randomly divided into control group (n=7), experimental group (n=7), and surgical group (n=7). Varicocele model was established in both the experimental and surgical groups, while only vein isolation was performed in the control group. After 8 weeks, spermatic vein diameter were measured in the control and experimental rats, and collected the left epididymis (fixed in formaldehyde and frozen in refrigerator at -80 ℃). In the surgical group, left high spermatic vein ligation was performed, and the left epididymis was collected after 4 weeks as in the control and the experimental groups. The fixed epididymis tissues were treated with HE staining for observation of tissue injuries. The miR-210 expression in the epididymis was detected with reverse transcription-polymerase chain reaction (RT-PCR). At last every group had 5 rats. Results: The pathological examination showed that the number and distribution of mature sperms in epididymal duct in the experimental group were lower and less even compared to the control group, while the two indicators in the surgical group were better than those in the experimental group. The diameter of the left spermatic vein in the experimental group and pre-treatment surgical group were significantly enlarged than in the control group (P<0.01). The expression of miR-210 in the left epididymis in the experimental group was significantly higher compared with the control group(1.32±0.06 vs 0.98±0.14, P<0.01), while the expression of miR-210 in the left epididymis in the surgical group was significantly decreased compared with the experimental group (0.96±0.16 vs 1.32±0.06, P<0.01); the difference between the control group and the surgical group was not statistically significant (P>0.05). Conclusion: The expression of miR-210 in the epididymis may be increased by varicocele and reduced after high ligation of the affected spermatic vein.

Comparison of two kinds of spermatic vein ligation in the treatment of varicocele with infertility

Objectives To explore the effects of different spermatic vein ligations for the varicocele with infertility, and find a more safe and effective method. Methods 35 cases of patients with varicocele sterility in our hospital from February 2012 to February 2014 were selected, who were divided into control group (17 cases) and observation group (18 cases), and were given laparoscopic spermatic vein ligation and microscopic varicocele ligation. Before and after the treatment, semen quality and postoperative complications of the two groups were observed and compared. Results Before the treatment, semen quality indexes of two groups had no significant difference (P>0.05). Semen quality indexes of two groups after treatment than before treatment had significantly improved (P<0.05), after 6 months treatment, the indexes of the two groups were statistically significant (P<0.05). Patients were followed up for 1~6 months, the two groups had no complications. Conclusions The patients with varicocele with infertility were treated spermatic vein ligation under the microscope, which can be better improve the patients' semen quality indexes. Key words: Varicocele; Ligation; Infertility, Male