Bipolar Electrothermal Vessel Sealing System and 5-mm 2 Expandable Trocar Approach in Pediatric Laparoscopic Varicocelectomy

Méndez-Gallart, Roberto; Casasnovas, Adolfo Bautista; Estevez-Martinez, Elina; Rodríguez-Barca, Pablo

doi:10.1097/sle.0b013e31823118d3

Cited by 3 publications

(2 citation statements)

References 25 publications

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“…Various groups have already reported good results with the single-port approach (39,40) . The initial open access for the umbilical scope has minimized complications secondary to the use of the Veress needle (41) 5 mm blunt-tip, bladeless ports are used, which avoids many minor complications such as incisional pain, hematoma, and fascial defects (42) . • Port position is well established -an umbilical scope and a right quadrant port.…”

Section: Discussionmentioning

confidence: 99%

15 years´ experience in the single-port laparoscopic treatment of pediatric varicocele with Ligasure technology

et al. 2023

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Introduction.Varicocele is an abnormal dilatation of the internal spermatic veins of the spermatic cord. It has an estimated prevalence of 15% in young male adults. Even though most of them are asymptomatic, scrotal pain and testicular hypotrophy are frequent in children and adolescents. There is controversy regarding the indications and optimal approach for treatment purposes. We present the results of our 15-year series in the laparoscopic repair of pediatric varicocele.Materials and methods. 238 patients diagnosed with varicocele and undergoing laparoscopic repair from 2006 to 2020 were reviewed. Variables collected included age, symptoms, grade, testicular atrophy, hospital stay, perioperative complications, recurrences, and formation of reactive hydrocele. Mean follow-up was 5.6 years (6 months-9 years).Results. Mean age was 14.1 years. 188 patients had grade III varicocele. In 14 cases, varicocele was bilateral. Testicular atrophy at diagnosis was found in 42% of patients, 74% of whom were over 15 years old. 51 patients had testicular pain. All patients underwent laparoscopic treatment. Mean operating time was 36 min. Median hospital stay was 31 h. Recurrence rate was 2.1%. 43 patients (18%) developed hydrocele, but only 27 (11.2%) required hydrocelectomy according to Lord's plication at least 1 year following laparoscopy. Of the remaining 16 cases, 2 spontaneously resolved and 14 remained stable in the mean 7-year follow-up. In 7.1%, paresthesias were noted in the anterior-internal aspect of the left thigh.Conclusion. Based on our series, we believe laparoscopy should be regarded as the gold standard technique in the pediatric population. Laparoscopic varicocelectomy is technically easy and fast, causes no pain, and has a recurrence rate of 1%. The procedures involving lymphatic vessel preservation could reduce reactive hydrocele rates as a long-term complication to a minimum.

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Section: Discussionmentioning

confidence: 99%

15 years´ experience in the single-port laparoscopic treatment of pediatric varicocele with Ligasure technology

et al. 2023

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“…El acceso abierto inicial para el puerto óptico umbilical ha minimizado las complicaciones secundarias al uso de la aguja de Verres (41) . Los trocares que empleamos son de 5 mm y punta roma sin cuchilla, lo que ha eliminado muchas complicaciones menores como el dolor en las incisiones, hematomas y defectos fasciales (42) . • La posición de los trócares está bien establecida: un trocar umbilical y otro en cuadrante derecho.…”

Section: Discussionunclassified

Quince años de experiencia en el tratamiento laparoscópico del varicocele pediátrico con un solo puerto de trabajo y tecnología Ligasure

Méndez-Gallart¹,

García-Palacios²,

Rodríguez-Barca³

et al. 2023

Cir Pediatr

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ResumenIntroducción. El varicocele es una dilatación anormal de las venas espermáticas internas del cordón espermático. Su prevalencia se estima en 15% de varones adultos jóvenes. Aunque la mayoría son asintomáticos, en niños y adolescentes el dolor escrotal y la hipotrofia testicular son frecuentes. Existe controversia sobre las indicaciones y el abordaje óptimo para su tratamiento. Presentamos los resultados de nuestra serie de 15 años en la reparación laparoscópica del varicocele pediátrico.Material y métodos. Revisamos 238 pacientes diagnosticados de varicocele y sometidos a corrección laparoscópica desde 2006 hasta 2020. Las variables registradas fueron: edad, síntomas, grado, atrofia testicular, duración de la estancia, complicaciones perioperatorias, recidivas y formación de hidrocele reactivo. El seguimiento medio fue 5,6 años (6 meses-9 años).Resultados. La edad promedio fue 14,1 años. 188 pacientes presentaban varicocele grado III. En 14 casos el varicocele era bilateral. Se observó atrofia testicular en 42% al diagnóstico, de los que el 74% eran mayores de 15 años. Cincuenta y un pacientes refirieron dolor testicular. Todos los pacientes se sometieron al tratamiento laparoscópico. El tiempo operatorio promedio fue 36 min. La mediana de estancia fue 31 horas. La tasa de recidiva fue 2,1%. Cuarenta y tres pacientes desarrollaron hidrocele (18%); pero solo 27 precisaron hidrocelectomía según plicatura de Lord al menos un año poslaparoscopia (11,2%). De los 16 restantes, dos se resolvieron espontáneamente y 14 se mantuvieron estables en el seguimiento medio de siete años. En 7,1% se notificaron parestesias en la cara anterointerna del muslo izquierdo.Conclusión. Basándonos en nuestra serie, creemos que la laparoscopia debe considerarse el gold standard en edad pediátrica. La varicocelectomía laparoscópica es técnicamente fácil y rápida, indolora y con una tasa de recurrencia del 1%. Los procedimientos de preservación de los linfáticos podrían reducir al mínimo las tasas de hidrocele reactivo como complicación a largo plazo.

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The Effect of Human Chorionic Gonadotropin Therapy on Semen Parameters and Pregnancy Rate after Varicocelectomy

Javanmard¹,

Behruz²,

Mohammadreza³

et al. 2018

Current Urology

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Introduction: To study the stimulating effect of human chorionic gonadotropin (hCG) on spermatogenesis in patients with varicocele and infertility undergoing varicocelectomy. Materials and Methods: In the study, 188 infertile patients with varicocele were included. Open inguinal varicocelectomy was performed. They were randomized into 2 groups and hCG (91 patients) was administered intramuscularly by dosage of 5,000 international units every week for 3 months. A semen analysis was obtained at 6 months, post-operatively and cases were followed for 2 years for pregnancy report. Results: Semen analysis of the patients shows a significant improvement in all parameters 6 months after varicocelectomy without any superiority between the 2 groups. During the follow-up, 56 couples (61.5%) in hCG treated and 22 couples (22.7%) in the group treated only by varicocelectomy achieved pregnancy. Patients treated with varicocelectomy plus hCG therapy had a significant superior pregnancy rate compared to the other group (P=0.0001). Conclusion: Administration of hCG in this group of infertile patients might be helpful in order to enhance pregnancy rate. However some more conclusive studies are needed to be able to recommend such therapy for infertile men due to varicocele.

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Bipolar Electrothermal Vessel Sealing System and 5-mm 2 Expandable Trocar Approach in Pediatric Laparoscopic Varicocelectomy

Abstract: Laparoscopic Palomo varicocele surgery for pediatric patients using Ligasure as spermatic vessels sealant and only 2 radially expandable 5-mm trocars is a safe, feasible, and time-effective technical improvement.

Cited by 3 publications

References 25 publications

15 years´ experience in the single-port laparoscopic treatment of pediatric varicocele with Ligasure technology

15 years´ experience in the single-port laparoscopic treatment of pediatric varicocele with Ligasure technology

Quince años de experiencia en el tratamiento laparoscópico del varicocele pediátrico con un solo puerto de trabajo y tecnología Ligasure

The Effect of Human Chorionic Gonadotropin Therapy on Semen Parameters and Pregnancy Rate after Varicocelectomy

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