Name: Grade III Varicocele Surgical Treatment using Spermatic Vein-Superficial Abdominal Vein Shunt (Video) | JoVE Journal
Uploaded: 2024-08-23T12:30:00.000+00:00
Duration: 5 min
Description: Learn microsurgical varicocele treatment using spermatic vein-superficial abdominal vein shunt for improved male fertility outcomes. This technique reduces postoperative complications and enhances venous drainage.

ai_agent_IP

ai_agent

maintenance

instantTrialDurationMinutes

isBiopharma

enableNewMyJoveSectionDesign

educationFeatures

seoMetaApi

ai_copilot_institution_blacklist

ai_chat_institution_blacklist

freeAccessWindow

ssoRoleCapture

scheduledMaintenanceBanner

joveLabsFeatures

disable_autoplay_for_bots

extended_trial_duration

5 minutes

This research was supported by a grant from the Guangdong Science and Technology Plan project, funded by the Department of Science and Technology of Guangdong Province (grant number: 2021A1515410004); Development Research Center of Medicine and Health Science and Technology, National Health Commission (grant number: HDSL202001007).

This study was approved by the ethics committee of the First Affiliated Hospital, Sun Yat-sen University (NO. 2020-478), prior to the start of the clinical study. All subjects provided informed consent before the study. The inclusion criteria for cases are (1) grade III varicocele confirmed by clinical palpation and ultrasonic examination of varicocele inner diameter &#8805; 3.1 mm and reflux time &#8805; 6 s; (2) Combined scrotal pain and discomfort; (3) Completed surgical treatment for varicocele in the hospital. Exclusion criteria: (1) any of the following pelvic-related histories: pelvic operation, pelvic radiotherapy, or pelvic trauma; (2) perineal skin disease; or (3) surgical contraindications.
1. High ligation of spermatic veins
<ol>
	<li>Administer intravenous-inhalational anesthesia and assess depth by disappearance of the patient&#39;s consciousness and pain response, as well as skeletal muscle relaxation.</li>
	<li>Make an external oblique incision parallel to the groin through the internal ring with a length of 3 cm. Cut the skin and subcutaneous tissue with a scalpel, and use a unipolar electric scalpel combined with blunt separation to separate the aponeurosis of the external oblique and internal oblique muscles. Then, on the outside of the incision, insert forceps through the internal obliquus into the retroperitoneum.</li>
	<li>Push open the peritoneal tissue with saline wet gauze and find the flexed and thickened spermatic vein in front of the psoas major muscle and behind the peritoneum while paying attention to protecting the artery.</li>
	<li>Open the spermatic cord sheath bluntly with a vascular clamp&#160;to carefully free a spermatic vein of about 6-8 cm in length to the proximal end. Lift the vascular sling, ligate the proximal end with a non-absorbable 2-0 suture, and cut. Lift the distal end knot and free it to the vicinity of the peritoneal junction. Use the spermatic vein with a larger diameter for subsequent spermatic vein-inferior epigastric vein shunt&#160;(Figure 1).</li>
	<li>Ligate other branches of the spermatic vein with a non-absorbable 2-0 suture.</li>
</ol>
2. Releasing the&#160;inferior epigastric vein
<ol>
	<li>On the medial aspect of the incision, identify and retract the spermatic cord. The inferior epigastric vein was located beneath the fascia surrounding the spermatic cord left to the internal ring.</li>
	<li>Lift the vascular sling, free the inferior epigastric vein with a sufficient length of about 3 cm towards its distal end and observe the direction of blood flow. After ligation with a non-absorbable 3-0 suture, excise the distal end and dissect the proximal end for subsequent anastomosis with the distal end of the spermatic vein with a vascular clamp&#160;(Figure 2).</li>
</ol>
3. Anastomosis of spermatic vein -&#160;inferior epigastric vein
<ol>
	<li>Relying on the manipulation of bending forceps, guide the spermatic vein carefully through the inner ring opening to the abdominal incision and secure with a vascular clamp in preparation for subsequent anastomosis with the inferior epigastric vein.</li>
	<li>Check that there is no tension in connection with the free spare superficial vein of the abdominal wall, and then suture 6-8 stitches with 8-0 Polypropylene suture (Figure 3).</li>
	<li>Release the&#160;vascular clamp&#160;to ensure that the vein is full, the blood flow is smooth, and there is no blood leakage when pressing the testicle.</li>
</ol>
4. Closing the incision
<ol>
	<li>To close the incision layer by layer, use 2-0 absorbable sutures to suture the external oblique aponeurosis and subcutaneous tissue. Use 3-0 absorbable sutures to suture the skin.</li>
</ol>
5. Postoperative management
<ol>
	<li>Ask the patient to pay attention to rest and avoid strenuous exercise. After surgery, administer a subcutaneous injection of 40 mg Enoxaparin Sodium, and the next day, switch to oral Rivaroxaban, 10 mg daily for 1 month.</li>
</ol>

<ol><li>World Health Organization. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/pubmed?term=((The+influence+of+varicocele+on+parameters+of+fertility+in+a+large+group+of+men+presenting+to+infertility+clinics%5BTitle%5D)+AND+%22Fertil+Steril%22%5BJournal%5D)">The influence of varicocele on parameters of fertility in a large group of men presenting to infertility clinics.</a> Fertil Steril. 57 (6), 1289-1293 (1992).</li>
<li>Goldstein, M. <a target="_blank" href="http://scholar.google.com/scholar?hl=en&safe=off&q=author%3aGoldstein%2C+M+%22Surgical+management+of+male+infertility%22">Surgical management of male infertility</a>. , Elsevier Saunders. Philadelphia, PA. 648-687 (2012).</li>
<li>Punjani, N., Wald, G., Gaffney, C. D., Goldstein, M., Kashanian, J. A. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/pubmed?term=((Predictors+of+varicocele-associated+pain+and+its+impact+on+semen+parameters+following+microsurgical+repair%5BTitle%5D)+AND+%22Andrologia%22%5BJournal%5D)">Predictors of varicocele-associated pain and its impact on semen parameters following microsurgical repair.</a> Andrologia. 53 (8), e14121(2021).</li>
<li>Jellad, S., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/pubmed?term=((Sperm+DNA+status+in+infertile+patients+with+clinical+varicocele%5BTitle%5D)+AND+%22Prog+Urol%22%5BJournal%5D)">Sperm DNA status in infertile patients with clinical varicocele.</a> Prog Urol. 31 (2), 105-111 (2021).</li>
<li>Jensen, C., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/pubmed?term=((Varicocele+and+male+infertility%5BTitle%5D)+AND+%22Nat+Rev+Urol%22%5BJournal%5D)">Varicocele and male infertility.</a> Nat Rev Urol. 14 (9), 523-533 (2017).</li>
<li>Ding, H., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/pubmed?term=((Open+non-microsurgical%2C+laparoscopic+or+open+microsurgical+varicocelectomy+for+male+infertility%3A+a+meta-analysis+of+randomized+controlled+trials%5BTitle%5D)+AND+%22BJU+Int%22%5BJournal%5D)">Open non-microsurgical, laparoscopic or open microsurgical varicocelectomy for male infertility: a meta-analysis of randomized controlled trials.</a> BJU Int. 110 (10), 1536-1542 (2012).</li>
<li>Mehta, A., Goldstein, M. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/pubmed?term=((Microsurgical+varicocelectomy%3A+a+review%5BTitle%5D)+AND+%22Asian+J+Androl%22%5BJournal%5D)">Microsurgical varicocelectomy: a review.</a> Asian J Androl. 15 (1), 56-60 (2013).</li>
<li>Tatem, A. J., Brannigan, R. E. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/pubmed?term=((The+role+of+microsurgical+varicocelectomy+in+treating+male+infertility%5BTitle%5D)+AND+%22Transl+Androl+Urol%22%5BJournal%5D)">The role of microsurgical varicocelectomy in treating male infertility.</a> Transl Androl Urol. 6 (4), 722-729 (2017).</li>
<li>Kim, S. O., Jung, H., Park, K. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/pubmed?term=((Outcomes+of+microsurgical+subinguinal+varicocelectomy+for+painful+varicoceles%5BTitle%5D)+AND+%22J+Androl%22%5BJournal%5D)">Outcomes of microsurgical subinguinal varicocelectomy for painful varicoceles.</a> J Androl. 33 (5), 872-875 (2012).</li>
<li>Pagani, R. L., Ohlander, S. J., Niederberger, C. S. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/pubmed?term=((Microsurgical+varicocele+ligation%3A+surgical+methodology+and+associated+outcomes%5BTitle%5D)+AND+%22Fertil+Steril%22%5BJournal%5D)">Microsurgical varicocele ligation: surgical methodology and associated outcomes.</a> Fertil Steril. 111 (3), 415-419 (2019).</li>
<li>Wang, L., Yang, Q., Xie, X., Dou, K. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/pubmed?term=((Microscopic+internal+spermatic+vein-+inferior+epigastric+vein+anastomosis+in+the+treatment+of+left+varicocele%3A+A+review+and+case+report%5BTitle%5D)+AND+%22Asian+J+Surg%22%5BJournal%5D)">Microscopic internal spermatic vein- inferior epigastric vein anastomosis in the treatment of left varicocele: A review and case report.</a> Asian J Surg. 46 (9), 3963-3964 (2023).</li>
<li>Salehzadeh, M., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/pubmed?term=((Evaluation+of+the+role+of+reflux+pattern+in+Color+Doppler+Ultrasound+on+spermogram+improvement+after+varicocelectomy%5BTitle%5D)+AND+%22Int+Urol+Nephrol%22%5BJournal%5D)">Evaluation of the role of reflux pattern in Color Doppler Ultrasound on spermogram improvement after varicocelectomy.</a> Int Urol Nephrol. 52 (12), 2245-2251 (2020).</li>
<li>Wan, X., Wang, H., Ji, Z. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/pubmed?term=((Microsurgical+varicocelectomy+for+clinical+varicocele%3A+A+review+for+potential+new+indications%5BTitle%5D)+AND+%22Andrologia%22%5BJournal%5D)">Microsurgical varicocelectomy for clinical varicocele: A review for potential new indications.</a> Andrologia. 49 (10), 10(2017).</li>
<li>Lv, K. L., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/pubmed?term=((Varicocele+anatomy+during+subinguinal+microsurgical+varicocelectomy+in+Chinese+men%5BTitle%5D)+AND+%22Andrologia%22%5BJournal%5D)">Varicocele anatomy during subinguinal microsurgical varicocelectomy in Chinese men.</a> Andrologia. 47 (10), 1190-1195 (2015).</li>
<li>Hopps, C. V., Lemer, M. L., Schlegel, P. N., Goldstein, M. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/pubmed?term=((Intraoperative+varicocele+anatomy%3A+a+microscopic+study+of+the+inguinal+versus+subinguinal+approach%5BTitle%5D)+AND+%22J+Urol%22%5BJournal%5D)">Intraoperative varicocele anatomy: a microscopic study of the inguinal versus subinguinal approach.</a> J Urol. 170, 6 Pt 1 2366-2370 (2003).</li>
<li>Mashour, G. A., Woodrum, D. T., Avidan, M. S. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/pubmed?term=((Neurological+complications+of+surgery+and+anaesthesia%5BTitle%5D)+AND+%22Br+J+Anaesth%22%5BJournal%5D)">Neurological complications of surgery and anaesthesia.</a> Br J Anaesth. 114 (2), 194-203 (2015).</li>
</ol>

The authors have no conflicts of interest to disclose.

Increasing evidence has shown that microsurgical varicocelectomy has more advantages than open or laparoscopic varicocelectomy for the surgical management of VC5,6. The surgical microscope can magnify the anatomical details with a clear field of vision, and the arteriovenous, lymphatic vessels and nerves can be discerned more readily. In contrast, it is difficult to distinguish the arteries and veins clearly in other surgical procedures. They may miss venous vessels for ligation or accidentally injure the accompanying lymphatic vessels and nerves, which leads to postoperative complications such as scrotal pain, testicular edema, and recurrence. Moreover, a sublingual or intralingual incision is usually adopted in microsurgical varicocelectomy, which is convenient for exposing the spermatic veins12,13. However, the internal spermatic veins in the inguinal canal are in the form of the pampiniform plexus with more complex branches in lower levels14,15. It is still challenging to avoid potential damage to the anatomy of the spermatic cord. Another fact that cannot be ignored is that varicocelectomy has not restored the normal venous drainage of the spermatic cord, which causes persistent testicular edema10.
Recently, microscopic varicocele repair using internal spermatic vein-inferior epigastric vein anastomosis has also been applied to the treatment of varicocele11. However, their primary focus is on diverting the blood from renal venous reflux to alleviate the burden on the kidneys, whereas our objective is to reinstate normal blood flow to the testicles. Similarly, we selected the grade III varicocele patients as study subjects, adopted a high ligation of the spermatic vein with fewer branches, and constructed the bypass from the spermatic vein to inferior epigastric vein under a microscope, which not only retained some of the advantages of varicocelectomy but also recovered the venous drainage of the spermatic cord to restore the testicular venous reflux. In this way, the stagnant venous blood in the testis can be drained after surgery, which is conducive to the vanishing of varicose veins on the surface of the scrotum.&#160;
In order to achieve successful surgery, it is necessary to separate veins of sufficient free length and ensure tension-free anastomosis. Moreover, searching for inferior epigastric vein is challenging and requires extensive anatomical knowledge.
There are some limitations that need to be addressed. The surgical protocol adds more surgical steps, although as time goes on, our surgical techniques continue to mature, and the surgical time continues to shorten.&#160;These steps might bring potential complications like bleeding and obstruction during anastomosis. It demands higher requirements for microsurgical techniques and postoperative management, including the application of anticoagulant drugs. Moreover, the protocol makes it impractical to ligate the external spermatic vein and the gubernaculum vein, which are inferred as the most common recurrence routes. Also, it is important to note that due to the short follow-up period, we need to further understand the evaluation of long-term outcomes such as semen quality and pregnancy rate. In addition, the operation time of group A was relatively long, which may bring the risks associated with the long operation time, such as anesthesia risk16. Moreover, verifying and ensuring long-term patency of the spermatic vein is also a subject that requires follow-up.

The incidence of varicocele (VC) in adult males is 11.7%, and in males with abnormal semen quality, the incidence is up to 25.4%1. Clinical manifestations include symptoms of ipsilateral testicular growth and developmental disorders accompanied by pain, discomfort, low fertility, and hypogonadism. Clinical specialist examinations can detect and grade varicocele2. VC III grade shows positive for clinical palpation and ultrasonic varicocele inner diameter &#8805; 3.1 mm and reflux time &#8805; 6 s, often accompanied by more severe testicular pain or swelling discomfort3,4.
Recent studies have shown that VC microsurgical varicocelectomy is considered to be the most effective way of VC repair due to its advantages of fewer complications and low recurrence rate5,6,7. However, this procedure has some shortcomings: as in the past, scrotal, inguinal, or subinguinal incisions are often used, which easily damage the cremaster muscle, testicular artery, vas deferens artery and lymphatic vessels. Especially in grade III VC, it is more likely to be accidentally injured due to the many branches of the pampiniform plexus, and damage to the normal anatomical structure of the spermatic cord will cause postoperative complications such as testicular pain, swelling, and atrophy8. Additionally, traditional varicocelectomy by simple ligation of the spermatic vein hinders the drainage of the stagnant venous blood of the affected testicle, resulting in a persistent scrotal appearance of varicose veins and slower remission of swelling sensation in postoperative patients with grade III VC and the relief of testicular pain or swelling discomfort is slow or not obvious, with poor efficacy9. It is conducive to restoring the physiological hemodynamics of the testes by varicocele repair rather than simple varicocelectomy10. For example, microscopic internal spermatic vein-inferior epigastric vein anastomosis has also been reported to be applied to the treatment of varicocele11. Here, we describe a protocol for grade III varicocele surgical treatment that aims to ligate spermatic veins at the high retroperitoneal level and rebuild the venous drainage of the spermatic cord by a spermatic vein-superficial abdominal vein (also known as superficial epigastrin vein or vena epigastrica superficialis) shunt under the microscope.
For this study, a retrospective analysis was performed on the clinical data of 96 patients in the hospital from June 2018 to August 2021 who had grade III VC and complained of testicular pain or distension discomfort, who had received spermatic vein ligation, and who had complete follow-up data. The pain score was assessed by visual scoring (VAS). They were divided into two groups according to the surgical methods: study group A was treated with high ligation of the spermatic vein under a microscope and transfer of spermatic venue-superficial abdominal vein (49 cases), and study group B was treated with low ligation of the spermatic vein under a microscope (47 cases).

<table><tbody><tr><td>Clexan (Enoxaparin Sodium Injection)</td><td>Sanofi (Beijing) Pharmaceutical Co., LTD</td><td></td><td></td></tr><tr><td>CROWNJUN (Nylon suture)</td><td>Kono Seisakusho Co., Ltd., Japan</td><td></td><td></td></tr><tr><td>Doppler ultrasonography</td><td>Mindray, Shenzhen, China</td><td>Resona R9</td><td></td></tr><tr><td>Microscope</td><td>Zeiss, Jena, Germany</td><td>OPMI PENTERO 800</td><td></td></tr><tr><td>Non-absorbable suture</td><td>Johnson, (Shanghai) Medical Equipment Co., LTD</td><td></td><td></td></tr><tr><td>Rivaroxaban</td><td>Bayer Healthcare GMBH</td><td></td><td></td></tr><tr><td>VICRYL (absorbable surgical suture)</td><td>Johnson, (Shanghai) Medical Equipment Co., LTD</td><td></td><td></td></tr></tbody></table>

grade iii varicocele surgical treatment using spermatic vein-superficial abdominal vein shunt

Grade III Varicocele Surgical Treatment using Spermatic Vein-Superficial Abdominal Vein Shunt

Microsurgical varicocelectomy is the most commonly used method for the treatment of varicocele (VC) in recent years. However, it is technically demanding with the risk of damaging the normal anatomical structure of the spermatic cord, such as the cremaster muscle, testicular artery, and vas deferens during the pampiniform plexus ligation. Also, traditional varicocelectomy hinders the drainage of the stagnant venous blood of the affected testicle, resulting in a persistent scrotal appearance of varicose veins and slower remission of swelling sensation in postoperative patients with grade III VC. Therefore, we developed a retroperitoneal varicocelectomy with a microscopical spermatic venous-superficial vein of the abdominal wall bypass procedure. The spermatic vein was transected and ligated proximally through the retroperitoneal space. Then, the distal spermatic vein was freed and passed through the internal ring; under the skin of the groin, a microscopic vascular anastomosis was performed to build the bypass of the distal spermatic vein and proximal inferior epigastric vein. The high ligation facilitates the protection of the normal anatomy of the spermatic cord, and the venous bypass allows rapid testicular blood drainage, which can effectively improve the degree of varicocele, testicular pain, and even spermatogenic function. In conclusion, the present protocol describes a promising way to reconstruct the spermatic return through high retroperitoneal ligation of the spermatic vein and anastomosis of the spermatic vein-inferior epigastric vein, which resulted in faster and more obvious improvement in symptoms and better prognosis of grade III VC.

For this study, the 96 patients were divided into two groups: study group A, treated with high ligation of the spermatic vein under a microscope and transfer of spermatic vein-inferior epigastric vein (49 cases), and study group B, treated with low ligation9,12,13,14,15 of the spermatic vein under a microscope (47 cases). The basic data, operation time, hospital stay, postoperative scrotal edema, testicular pain or swelling discomfort score, and the remission of varicocele were compared between the two groups for 1 month after the operation. The measurement data were expressed as mean ± standard deviation, and an independent sample t-test was used for comparison. Count data is expressed as percentages (%) and compared using the chi-square test with p &lt;0.05, indicating a statistically significant difference.
There were no significant differences in age, BMI, varicosity degree, and testis pain score between the 2 groups (p&gt;0.05; Table 1). There was no significant difference in the length of hospital stay between group A and group B, 5.32 ± 0.42 days vs. 5.16 ± 0.28 days (p&gt;0.05; Table 2). However, the operation time of group A was significantly longer than that of group B, 146.26 ± 14.33 min vs. 92.27 ± 8.66 min, and the difference was statistically significant (p&lt;0.01; Table 2). The incidence of postoperative scrotal edema or hydrocele of testis and acute epididymitis in group A was lower than those in group B (0% vs.5.1%, 0% vs.6.0%, 0.9% vs.7.7%, respectively; p&lt;0.05; Table 2). The relief rates of testicular pain or distention discomfort in group A and group B, 1 month after surgery, were 91.8% and 61.78%, respectively (Table 2). The decrease in varicocele was 0.16 ± 0.06 mm vs. 0.08 ± 0.04 mm for group A and group B, respectively, and the difference was statistically significant (p&lt;0.05; Table 2).
<img alt="Surgical procedure diagram, incisions, retractors, anatomy, medical study, human tissue exposure." class="xfigimg" src="/files/ftp_upload/65048/65048fig01.jpg" data-altupdatedat="1788304762000" data-alt="Figure 1"> 
Figure 1: Dissociation of a spermatic vein of sufficient length. Selection of a spermatic vein with a larger diameter for subsequent spermatic vein-superficial abdominal vein shunt. <a href="https://www.jove.com/files/ftp_upload/65048/65048fig01large.jpg" target="_blank">Please click here to view a larger version of this figure.</a>
<img alt="Surgical procedure demonstrating nerve exposure; incision with retractor and forceps; medical technique." class="xfigimg" src="/files/ftp_upload/65048/65048fig02.jpg" data-altupdatedat="1788304762000" data-alt="Figure 2"> 
Figure 2:  Dissociation of inferior epigastric vein of sufficient length. Ensure that the length and diameter is to the reserved spermatic vein. <a href="https://www.jove.com/files/ftp_upload/65048/65048fig02large.jpg" target="_blank">Please click here to view a larger version of this figure.</a>
<img alt="Surgical suturing technique, close-up, showing tissue repair procedure, educational medical study." class="xfigimg" src="/files/ftp_upload/65048/65048fig03.jpg" data-altupdatedat="1788304762000" data-alt="Figure 3"> 
Figure 3: Reconstruction of the bypass. Reconstructed bypass between spermatic vein and superficial abdominal wall vein under microscope. <a href="https://www.jove.com/files/ftp_upload/65048/65048fig03large.jpg" target="_blank">Please click here to view a larger version of this figure.</a>
<table border="1" fo:keep-together.within-page="1" fo:keep-with-next.within-page="always">
	<tbody>
		<tr>
			<td>Item </td>
			<td> Group A</td>
			<td> Group B</td>
			<td>T value</td>
			<td>P value</td>
		</tr>
		<tr>
			<td>Number of cases</td>
			<td>47</td>
			<td>49</td>
			<td></td>
			<td></td>
		</tr>
		<tr>
			<td>Age (years)</td>
			<td>32. 6±5. 4</td>
			<td>30. 8±5. 1</td>
			<td>1.16</td>
			<td>0.14</td>
		</tr>
		<tr>
			<td>BMI</td>
			<td>20.64±3.34</td>
			<td>20.09±3.91</td>
			<td>0.83</td>
			<td>0.38</td>
		</tr>
		<tr>
			<td>Course of disease (years)</td>
			<td>3.8±1.3</td>
			<td>4.3±1.4</td>
			<td>-1.682</td>
			<td>0.078</td>
		</tr>
		<tr>
			<td>Width of spermatic vein (cm)</td>
			<td>3.62±0.41</td>
			<td>3.67±0.35</td>
			<td>- 0. 665</td>
			<td>0.512</td>
		</tr>
		<tr>
			<td>Testicular pain VAS score</td>
			<td>3.6±1.5</td>
			<td>3.4±1.7</td>
			<td>0.186</td>
			<td>0.398</td>
		</tr>
	</tbody>
</table>
Table 1: Comparison of preoperative baseline data of patients. The measurement data are expressed as mean ± standard deviation, and an independent sample t-test is used for comparison. Count data is expressed as percentages (%) and compared using the chi-square test with p &lt;0.05, indicating a statistically significant difference.
<table border="1" fo:keep-together.within-page="1" fo:keep-with-next.within-page="always">
	<tbody>
		<tr>
			<td colspan="2">Item</td>
			<td> Group A</td>
			<td> Group B</td>
			<td>T value</td>
			<td>P value</td>
		</tr>
		<tr>
			<td colspan="2">Operation time</td>
			<td>146.26±14.33</td>
			<td>92.27±8.66</td>
			<td>6.5</td>
			<td>0.015</td>
		</tr>
		<tr>
			<td colspan="2">Length of stay</td>
			<td>5.32±0.42</td>
			<td>5.16±0.28</td>
			<td>1.7</td>
			<td>0.093</td>
		</tr>
		<tr>
			<td colspan="2">1 month after surgery for narrowing the width of the spermatic vein (cm)</td>
			<td>0.16±0.06</td>
			<td>0.08±0.04</td>
			<td>-1.7</td>
			<td>&lt;0.01</td>
		</tr>
		<tr>
			<td colspan="2">Rate of relief from testicular pain or discomfort</td>
			<td>91.80%</td>
			<td>61.78%</td>
			<td></td>
			<td>0.047</td>
		</tr>
		<tr>
			<td>Complication</td>
			<td>Scrotal edema</td>
			<td>1</td>
			<td>3</td>
			<td></td>
			<td></td>
		</tr>
		<tr>
			<td>(Number of cases)</td>
			<td>Epididymitis</td>
			<td>0</td>
			<td>1</td>
			<td></td>
			<td></td>
		</tr>
		<tr>
			<td></td>
			<td>Hydrocele</td>
			<td>0</td>
			<td>1</td>
			<td></td>
			<td></td>
		</tr>
		<tr>
			<td></td>
			<td>Atrophy of testis</td>
			<td>0</td>
			<td>0</td>
			<td></td>
			<td></td>
		</tr>
	</tbody>
</table>
Table 2: Comparison of perioperative indexes. The measurement data are expressed as mean ± standard deviation, and an independent sample t-test is used for comparison. Count data is expressed as percentages (%) and compared using the chi-square test with p &lt;0.05, indicating a statistically significant difference.

Here, we present a protocol for grade III varicocele surgical treatment that aims to rebuild the venous drainage of the spermatic cord by a spermatic vein-superficial abdominal vein shunt performed under the microscope.

Microsurgical varicocelectomy is the most commonly used method for the treatment of varicocele (VC) in recent years. However, it is technically demanding ...

grade-iii-varicocele-surgical-treatment-using-spermatic-vein

Research

JoVE Journal

Medicine

The present protocol describes a vessel-sparing, longitudinal intussusception vasoepididymostomy using readily available single-needle sutures in China, a safe and effective procedure, which may improve patients' patency and natural pregnancy rates.

Vessel-Sparing Microsurgical Longitudinal Intussusception Vasoepididymostomy to Treat Epididymal Obstructive Azoospermia

This protocol presents the clinical application of a 24 G cannula and 3-0 polypropylene suture as a simple and effective method for the exploration of the vas deferens.

Clinical Application of 24 G Cannula Needle and 3-0 Polypropylene Suture in Vas Deferens Exploration

Here, we present a protocol to preserve the vasal vessels in microsurgical vasoepididymostomy. The surgical security is enhanced by preserving the vasal vessels using a retrograde-anterograde dissociation and fixing the vasal vessels.

A Modified Vessel-Sparing Microsurgical Vasoepididymostomy

To reduce the postoperative recurrence rate of varicocelectomy, we combined high ligation of varicocele with intraoperative embolization. We injected polidocanol from the spermatic vein during surgery to embolize the branches of the spermatic vein and collateral veins. This is an alternative surgical method for the treatment of varicocele.

Combination of High Ligation and Intraoperative Embolization Using Polidocanol for Treatment of Varicoceles

This protocol outlines the use of transcutaneous neuromuscular electrical stimulation for treating varicocele-induced scrotal pain. It compares visual analog scale (VAS) scores and imaging changes before and after treatment to assess effectiveness. Results indicate that patients experienced improved scrotal pain symptoms following the treatment.

Transcutaneous Neuromuscular Electrical Stimulation for Treating Varicocele-Induced Scrotal Pain

Varicocele accounts for 35%-40% of infertility cases among men of reproductive age. The international standard treatment method is microscopic varicocelectomy, typically performed under general anesthesia. This study proposes and implements microscopic varicocelectomy under local anesthesia, which provides more humane care for patients and reduces the economic burden.

Microscopic Varicocelectomy under Local Anesthesia as the Treatment of Varicocele

Varicocele relies heavily on angiographic diagnostic techniques for disease-related examination and assessment. In order to diagnose varicocele better, we combined supine and standing positions for varicocele imaging, and contrast-enhanced ultrasound is used for patients with inconspicuous reflux. This approach facilitates the early detection, diagnosis, and treatment of varicocele.

Combined Supine and Standing Imaging for Varicocele: An Improved Diagnostic Approach

A thermal tumor ablation procedure is described. The entire procedure is detailed, including pretreatment planning and imaging studies, anesthesia, adjuvant techniques to facilitate a percutaneous approach, imaging guidance of the ablation device to the tumor, thermal treatment, post-treatment care and follow-up.

Thermal Ablation for the Treatment of Abdominal Tumors

Protocol for propagation of dissociated high grade glioma surgical specimens in serum-free neurosphere medium to select for cells with cancer stem cell phenotype. For specimens that fail to grow as neurospheres, an alternative protocol is suggested. A paraffin embedding technique for maintaining the 3D neurosphere architecture for immunocytochemistry is described.

Optimization of High Grade Glioma Cell Culture from Surgical Specimens for Use in  Clinically Relevant Animal Models and 3D Immunochemistry

Experimental animal research plays a pivotal role in the development of clinical transplantation practice. The porcine orthotopic liver transplantation model (OLTx) closely resembles human conditions and is frequently used in clinically oriented research. The following protocol contains all information for a reliable porcine OLTx model using an active porto-caval-jugular shunt.

Technique of Porcine Liver Procurement and Orthotopic Transplantation using an Active Porto-Caval Shunt

Learn microsurgical varicocele treatment using spermatic vein-superficial abdominal vein shunt for improved male fertility outcomes. This technique reduces postoperative complications and enhances venous drainage.

Grade III Varicocele Surgical Treatment using Spermatic Vein-Superficial Abdominal Vein Shunt

Explore More Videos