Microscopic Varicocelectomy under Local Anesthesia as the Treatment of Varicocele

Varicocele is linked to 35%to 40%of male infertility cases during reproductive years. The globally accepted approach for treating this condition is through microscopic radical disease conducted under general anesthesia. This protocol demonstrates this surgery using local anesthesia to improve patient comfort and reduce financial costs.

This new one should significantly shorten required surgery time and offers opportunities for patients who cannot undergo general anesthesia. Under local anesthesia, we can more clearly observe the positions of symptomatic bacteria, which helps us make more precise solution under protection. We will focus on the changes in the smaller according after the surgery.

Because many patients seem improve after surgery but still cannot conceive naturally. Based on our preliminary research, we speculate that small arm coating may play an important role in this process. To begin, place the patient in a supine position on the operating table.

Insert a vein detained needle into the radial vein, and use an electrocardiogram monitor to track the patient's heartbeat and blood pressure. Then use fingers to palpate the spermatic cord at the base of the scrotum, following it upwards until the external inguinal ring is felt at 1.5 centimeters above the midpoint of the inguinal ligament. After injecting local anesthesia, use hemostatic forceps to grasp the skin to assess the efficacy of anesthesia, and mark the incision site with methylene blue.

Using a scalpel, make a three centimeter transverse or longitudinal incision at the external inguinal ring. Sequentially, incise the skin, the Camper's fascia and the Scarpa's fascia using an electrotome. Identify the spermatic cord, which under direct vision appears as a strip with dilated deep blue veins and the vas deferens palpable below it.

Exteriorize the spermatic cord from the incision with an appendiceal retractor. Use an electrotome to dissect the cremaster muscle and the external and internal spermatic fascia of the cord. Under eight to 10x magnification, observe the pulsation of the arteries to determine their location.

Carefully identify the spermatic artery, which is surrounded by small veins, has visible pulsation, and a tensed wall. Use micro scissors and forceps for blunt dissection and mark the artery with a moistened strip for identification. Identify and isolate the large spermatic veins.

Use micro titanium clips to clamp both ends of the vein before cutting. Further, dissect and identify small veins adjacent to the spermatic artery. Clamp them with micro titanium clips before cutting.

For vessels that are difficult to clamp with titanium clips, use four zero coated braided silk to perform ligation before cutting. After ligation, suture the cremaster muscle and both the internal and external spermatic fascia using a six zero absorbable surgical suture. Using this protocol, varicocelectomy was performed on 158 males, aged 21 to 51 years, diagnosed with varicocele and decreased semen quality.

The average surgery time was 100.11 minutes. Post-surgery, there was a significant overall improvement in semen quality by the third month. The progressive motility rate also increased from 20.23%to 25.84%