Two Trocar Laparoscopic Varicocelectomy: Approach and Outcomes

BACKGROUND AND OBJECTIVES: The surgical indications and proper management of varicoceles in the pediatric population continue to be controversial. Historically, open surgical approaches have had recurrence rates between 2% to 6% and a low rate of complications. We present a modified laparoscopic technique for the treatment of clinically significant varicoceles. METHODS: Consecutive pediatric patients presenting with clinically significant varicoceles between May 2000 and July 2003 were considered for laparoscopic varicocelectomy. A 5-mm 2-port laparoscopic varicocelectomy was performed, with supraumbilical and contralateral lower quadrant placement of the trocars. The Harmonic scalpel was used to fulgurate the spermatic vessels in a nonartery sparing technique. RESULTS: Ten clinically significant varicoceles were identified in 9 patients, all of which were ligated with this technique. One patient was treated for bilateral varicoceles. Average operating room time was 53 minutes (range, 45 to 65). All patients were discharged from the ambulatory surgery unit and returned to their regular physical activity within 2 weeks after surgery. Upon clinical reevaluation 6 weeks post surgery, there was no evidence of varicocele recurrence or hydrocele formation, and all patients were asymptomatic. CONCLUSIONS: Our 2-port laparoscopic varicocelectomy is comparable to traditional open surgical approaches in recurrence and complication rates. This laparoscopic repair may be superior to open techniques in operating time, convalescence, and cosmesis. The procedure is easily mastered and does not require microsurgical skills.