Doppler-controlled microsurgical subinguinal varicocelectomy: a single centre experience

Abstract

Introduction. Injury to the testicular artery during microsurgical subinguinal varicocelectomy (MSV) results in testicular atrophy in 20 – 40% of cases. The use of techniques that improve visualization of the testicular artery could increase the efficacy and safety of MSV. Objective. To evaluate the effect of intraoperative Doppler control (IDC) on the outcomes of microsurgical subinguinal varicocelectomy. Materials & methods. Retrospective cohort study. The study included 101 patients with clinical left-sided varicocele who underwent surgical treatment at the «Mother and Child Yaroslavl» clinic between January 2022 and November 2023. Fifty-two patients underwent standard microsurgical subinguinal varicocelectomy (MSV group), while 49 patients had MSV with intraoperative Doppler control (MSV + IDC group). The intraoperative Doppler control was performed using the Minimax-Doppler-K 20 MHz («SP Minimax», St. Petersburg, Russia). Intraoperatively, the number of preserved arterial and ligated venous stems was counted. Three months after the surgery, the presence of postoperative complications and changes in pain syndrome were assessed. Results. The average surgery time was 79.5 ± 11.3 minutes in the MSV group and 75.4 ± 12.1 minutes in the MSV + IDC group (p = 0.083). Multiple branches of the testicular artery were observed in 77.6 % of patients in the MSV + IDC group compared to 36.5 % in the MSV group (p < 0.001). The mean number of ligated veins was 16.7 ± 2.9 in the MSV + IDC group versus 15.0 ± 3.8 in the MSV group (p = 0.014). No differences were found in the number of preserved lymphatic vessels between the groups. Three months after surgery, no complications such as varicocele recurrence, hydrocele, or testicular atrophy were reported. Pain relief three months post-surgery was noted in 66.7% and 91.7 % of patients with preoperative pain syndrome in the MSV and MSV + IDC groups, respectively (p = 0.047). Conclusion. The utilisation of intraoperative Doppler control during microsurgical subinguinal varicocelectomy permits the preservation of a greater number of branches of the internal testicular artery, the ligation of a larger number of veins, and the attainment of superior outcomes with respect of post-operative pain relief.

Keywords

• microsurgical subinguinal varicocelectomy
• marmar procedure
• intraoperative doppler control
• intraoperative doppler