Modified Inguinal Microscope-Assisted Varicocelectomy under Local Anesthesia: A Non-randomised Controlled Study of 3565 Cases

Abstract

Varicocele is a common abnormality, but the conventional microsurgical subinguinal varicocelectomy (CMSV) has some disadvantages. We invented Modified Inguinal Microscope-Assisted Varicocelectomy (MIMV) under local anesthesia. This study aims to evaluate MIMV by comparing it to CMSV in operating duration, time to return to normal activity, postoperative complications, achievement of natural pregnancy and improvement of semen quality for patients with infertility, pain score for those with scrotal pain, and so on. We enrolled 3089 patients who underwent MIMV and 476 who underwent CMSV in our hospital. Both the operating duration and the time to return to normal activity of MIMV was shorter than that of CMSV (P < 0.001). The recurrence rate (P < 0.001) and injury rate of vas deferens (P = 0.011) after MIMV were lower than that after CMSV. Moreover, patients with MIMV showed higher degree of satisfaction with the surgery experience and outcome than those with CMSV (P < 0.001). However, no statistical difference was found between the two groups in scores of pain due to surgery, postoperative varicose veins diameters, reflux duration, and the postoperative complications of wound infection, hydrocele, atrophy of testis, epididymitis, and scrotal hematoma. In summary, MIMV is a promising varicocelectomy and could be applied more in clinical practice.

Prospective Comparison of Local Anesthesia with General or Spinal Anesthesia in Patients Treated with Microscopic Varicocelectomy

“…On the contrary, a retrospective study that included 3565 patients with varicocele demonstrated that pain relief in patients treated with inguinal MSV under LA (2% lidocaine) was comparable to the patients treated with subinguinal MSV under GA or SA [ 10 ]. This discrepancy could be attributed to the different anesthetic and surgical regimens.…”

“…The preferred anesthesia technique depends on several factors, including the procedure’s suitability for the patient, surgeon choice, patient acceptance, safety, perioperative pain control, the time to return to normal activity, the need for monitoring, and cost-effectiveness. LA is associated with reduced pain, decreased postoperative analgesic requirement, less need for postoperative care, lowered postoperative nausea and vomiting complications, a short anesthesia time and a short hospital stay, compared with GA [ 10 , 11 ]. Although many studies have compared LA and SA or GA for hernia repair, limited studies have compared them for varicocelectomy, and it is not clear whether LA is a suitable alternative to SA or GA for the procedure.…”

“…A retrospective study that included 3565 patients with varicocele demonstrated that inguinal MSV under LA (2% lidocaine) was superior to subinguinal MSV under GA or SA in operating duration and time to return to normal activity. However, no statistical difference was found in pain scores due to surgery [ 10 ]. An RCT study enrolled 60 patients who underwent subinguinal varicocelectomy and indicated that the visual analog scale (VAS) of pain under LA (2% prilocaine) was comparable with patients under SA, postoperatively.…”