spermatic vein resection

The varicocele reflow varicocele refers to the expansion of the veins in the spermatic cord due to obstruction of the reflux. It is a common disease in young and middle-aged people. It refers to the vasodilatation, distortion and lengthening of the spermatic plexus (venous vascular plexus) caused by the accumulation of spermatic vein blood flow. The incidence rate is 10-15% for males and 15-20% for male infertility. The varicocelectomy is mainly performed through the axillary retroperitoneal and transvaginal canal. It is not necessary to add shunt. The main reasons for the failure of the operation are the leakage of the vein branch and the damage of the internal spermatic artery. Treatment of diseases: spermatic varicocele varicocele Indication 1, varicocele with infertility; 2. Patients with severe varicocele; 3. Patients with bilateral varicocele; 4, mild, moderate varicocele do not have abnormal semen quality or obvious symptoms (such as bulging, pain) or testicular shrinkage, soft texture; 5, adolescent patients are limited to severe varicocele, obvious symptoms (sustained pain) and ipsilateral testicular growth retardation, volume reduction. Contraindications 1) Secondary varicocele. 2) Primary varicocele if the side branch is poorly refluxed, there is collateral regurgitation. Preoperative preparation 1. Semen analysis to see if there is sperm suppression. 2. Straight endocrine and anti-sperm antibodies are checked to see if there are other factors that cause semen abnormalities. 3. Clean the skin of the surgical field. 4, the use of spinal anesthesia or epidural anesthesia should be routinely fasted, banned before surgery. Surgical procedure The patient is placed in the Trendelenbur position (30°). A vertical median skin incision was made 2 to 3 cm below the umbilicus. After the pneumoperitoneum penetrated into the pneumoperitoneum, a 5 mm cannula was inserted. The peritoneal contents can be seen by inserting a 5 mm laparoscope into the umbilicus. The other two sleeves can be placed 3-5 cm on the inner ring. The position is more toward the head than the Mai's point. A 3 mm cannula was inserted into the 3 mm skin incision. When the laparoscopic and surgical instruments are placed, attention should be directed to the identification and dissection of the spermatic vein. Make a peritoneal incision about 3 to 4 cm parallel to one side of the spermatic vascular bundle. If the sigmoid colon is fixed over the spermatic vein and toward the anterior end of the inner ring, the sigmoid colon must be moved to expose the underlying spermatic vessels. In the middle of the incision, a second vertical incision is made from the peritoneum covering the spermatic vessels. The center passes through. This T-shaped incision provides adequate exposure to the spermatic vein. The entire line of the spermatic vessels was dissected from the underlying psoas muscle. Once the spermatic vessels are loosened, you may see 3-8 veins. Carefully divide the vascular bundle into the lateral and medial portions to identify the location of the spermatic artery, and the pulsation of the spermatic artery can be seen on either side. It must be carefully distinguished whether the pulsation of the spermatic artery or the pulsation transmitted by the radial artery. In general, arteries can be found in the center of the spermatic tract, and if the arteries are difficult to identify, a laparoscopic Doppler probe and/or papaverine or 2% lidocaine can be applied to the vascular bundle, which will identify and Dissection of the arteries becomes easy. Once the artery is determined, the non-arterial tissue is clipped and broken. To avoid damage to the spermatic artery, do not use a monopolar coagulator. After the completion of varicose vein ligation, a systematic examination of the peritoneum is performed, especially in the vicinity of the operating area, and sometimes the patient is accompanied by an inguinal hernia, which can also be repaired by laparoscopy. complication Common complications after spermatic vein ligation include postoperative edema, testicular artery injury, and recurrence of varicocele. 1. Edema: Edema after varicocele ligation is the most common complication, the incidence rate is 3% to 33%, with an average of 7%. Lymphatic injury or ligation is the main cause of edema. 2, testicular artery injury: postoperative testicular atrophy or sperm deficiency, mostly due to ligation or injury to the testicular artery. Animal experiments and studies of humans have shown that testicular artery ligation can cause testicular damage to a large extent, especially in infertile patients. 3, varicocele recurrence: recurrence rate after spermatic vein ligation was 0.6% to 45%. Most common in adolescent patients. Most of them cause recurrence due to technical or anatomical factors, missed or incapable of simultaneously treating the external veins of the internal spermatic vein system. The outer ring approach uses microdissection techniques to treat all veins with a low recurrence rate.