Single port varicocelectomy using SILS™ multiple access port

PURPOSE: Several surgical approaches have been used for varicocelectomy. We report single port varicocelectomy using SILS™ (Covidien, Norwalk, CT) multiple access port. CASE: The greade III varicocele patient was 23 years old and placed in supine position. About 2 cm vertical skin incision was made in a crease just lateral to the umbilicus and SILS™ port was placed with three 5-mm trocars. Incision to posterior peritoneum from the point 3 cm superior to the internal inguinal was made by needle holder with a broken 15th blade tip. The testicular vessels were exposed. The lymphatic vessels and testicular artery were identified and separated from the testicular vein with flexible laparoscopic instruments and conventional rigid instruments. Three testicular veins were clipped with hemoclips (EndoClip , Autosuture, Norwalk, CT). Posterior peritoneum was repaired with 4-0 vicryl with one side of 5 mm Hem-o-lok clip (Weck Research,Triangle Park, NC). Than the distal end of suture site was also closed with Hem-o-lok. RESULTS: The whole procedure was completed with no complication. The operative time was 85 minutes, and blood loss was minimal. The patient was discharged 2 days after the operation. Left scrotal pain and vein engorgement was disappeared. CONCLUSIONS: Our single port varicocelectomy method is a safe and effective alternative to conventional method. This will provide minimally invasive surgical option for varicocele and we can expect more potential cosmetic benefit and less morbid.