Endoscopic varicocelectomy by extraperitoneal route: a novel technique.

Background: Varicocelectomy for male infertility has been performed laparoscopically by transabdominal preperitoneal (TAPP) approach. Laparoscopic varicocelectomy (LV) has a potential risk of intraperitoneal injuries. LV fails to tackle the possible collateral veins in inguinal canal below the deep inguinal ring. Despite the inherent benefits of retro or extraperitoneal approach for urological procedures, the extraperitoneal varicocelectomy has not been widely practiced. Energy sources have been suspected in potential trauma to vas. Totally extraperitoneal (TEP) approach is a well established procedure for inguinal region. We utilized TEP approach to perform varicocelectomy without using energy source.

Method: Between January 2000 and March 2005 16 males having bilateral varicocele, subnormal semen parameters and inability to father a child with reproductively healthy female partner were operated. Varicocelectomy was done by TEP route.

Results: 16 males having different grades of varicocele, mean sperm counts of 29.25 million/ml and mean sperm motility of 26% were operated. There was no technical difficulty, visceral injury, conversion, bleeding or need to use energy source. There was no recurrence or reduction in testicular size. Postoperative hydroceles (11 out of 32 varicoceles) resolved within 3 months without any intervention. Mean sperm counts and motility improved to 68.25 million/ml and 63.18% respectively. Pregnancy was reported by 11 couples during a follow up of 2 years.

Conclusion: Endoscopic varicocelectomy by extraperitoneal route is a safe procedure.