Evaluation of the utility of laparoscopic Doppler ultrasound during Laparoscopic Varicocelectomy: a Randomized Clinical Trial
Objective: To evaluate the benefits of the utility of laparoscopic Doppler ultrasound (LDU) during laparoscopic varicocelectomy and compare the surgical outcomes and complications between LDU assisted laparoscopic varicocelectomy with internal spermatic artery(ISA) preservation(LDU-LV) and laparoscopic varicocelectomy with ISA ligation(LV) for infertile patients with varicoceles.In addition, our study aimed to describe the number and relationship of veins and arteries within the suprainguinal portion of the spermatic cord in infertile men undergoing LDU assisted laparoscopic varicocelectomy.Methods: A total of 147 infertile patients with varicoceles were randomly divided into LDU-LV group(n=72) and LV group (n=75) between October 2012 and February 2014.We compared patients” operative and postoperative parameters, semen parameters and the pregnancy rate between the two groups.The mean follow-up period was 20 months (range 14-30 months).Results: The operative time was significantly longer in LDU-LV group than LV group (40.97±10.96 min vs 24.09±6.45 min P<0.01).A mean number of 4.79 internal spermatic veins and 1.17 internal spermatic arteries were identified per cord in the suprainguinal dissection.68.2% of the internal spermatic arteries were accompanied by a single internal spermatic vein closely, 18.2% of the internal spermatic arteries were surrounded by a dense network of adherent veins.Only 13.6% were isolated and anterior to the veins.The postoperative hospital stay showed no significant difference (4.31±0.88 vs 4.53±0.75 days, p>0.05).Postoperative varicocele recurrence showed no significant difference (1 of 75 vs 1 of 72, p>0.05).The incidence of postoperative hydrocele was 2.8%(2/72) in LDU-LV group versus 12% (9/75) in LV group, which showed significant difference(P<0.05).Sperm concentration and sperm motility were significantly increased in both groups at 3, 6 and 12 months after surgery (P<0.01).The sperm concentration and sperm motility were higher in LDU-LV than LV group (33.71±7.30 vs 26.37±6.61 (× 106/ml) for sperm concentration P<0.05, 40.66±6.38vs 36.38±6.19 for sperm motility, P<0.05) at 12 month after surgery.Sperm morphology was comparable between the two groups.The pregnancy rate showed no significant difference(44.4% of the LDU-LV versus 37.3% of the LV, p>0.05).Conclusion: The number of internal spermatic vein may be highly variable and less than those reported at the inguinal and subinguinal level.Internal spermatic arteries at the suprainguinal level are likely to be accompanied by a single internal spermatic vein closely.Compared with LV, LDU-LV could safely and effectively ligate all spermatic veins and preserve spermatic arteries without leading to high varicocele recurrence and postoperative hydrocele, though may consume more operative time.Given the additional demonstrated benefit of sperm counts as well as sperm motility favouring LDU-LV, we recommend LDU should be routinely used as an effective tool to improve outcomes and safety of laparoscopic varicocelectomy.
varicocele laparoscopic Doppler ultrasound laparoscopic varicocelectomy
Guoliqiang liuyuqiang yuanmingzhen
The second hospital of Shandong University Jinan China 250033
国内会议
济南
英文
182-205
2016-09-03（万方平台首次上网日期，不代表论文的发表时间）