<meta charset="utf8"></head><body>국소 마취하에 미세수술 정맥류 제거

<ol>
	<li>Alsaikhan, B., Alrabeeah, K., Delouya, G., Zini, A. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Epidemiology+of+varicocele.">Epidemiology of varicocele.</a> Asian J Androl. 18 (2), 179-181 (2016).</li><li>Damsgaard, J., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Varicocele+is+associated+with+impaired+semen+quality+and+reproductive+hormone+levels:+A+study+of+7035+healthy+young+men+from+six+European+countries.">Varicocele is associated with impaired semen quality and reproductive hormone levels: A study of 7035 healthy young men from six European countries.</a> Eur Urol. 70 (6), 1019-1029 (2016).</li><li>Gupta, C., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Microscopic+varicocelectomy+as+a+treatment+option+for+patients+with+severe+oligospermia.">Microscopic varicocelectomy as a treatment option for patients with severe oligospermia.</a> Investig Clin Urol. 59 (3), 182-186 (2018).</li><li>Addar, A. M., Nazer, A., Almardawi, A., Al Hathal, N., Kattan, S. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=The+yield+of+microscopic+varicocelectomy+in+men+with+severe+oligospermia.">The yield of microscopic varicocelectomy in men with severe oligospermia.</a> Urol Ann. 13 (3), 268-271 (2021).</li><li>Saredi, G., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Feasibility+of+local+anesthesia+for+varicocele+correction+in+one-day-surgery+setting.+A+single+center+experience.">Feasibility of local anesthesia for varicocele correction in one-day-surgery setting. A single center experience.</a> Arch Ital Urol Androl. 93 (2), 233-236 (2021).</li><li>Jensen, C. F. S., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Varicocele+and+male+infertility.">Varicocele and male infertility.</a> Nat Rev Urol. 14 (9), 523-533 (2017).</li><li>Baazeem, A., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Varicocele+and+male+factor+infertility+treatment:+A+new+meta-analysis+and+review+of+the+role+of+varicocele+repair.">Varicocele and male factor infertility treatment: A new meta-analysis and review of the role of varicocele repair.</a> European Urol. 60 (4), 796-808 (2011).</li><li>Maheshwari, A., Muneer, A., Lucky, M., Mathur, R., Mceleny, K. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=A+review+of+varicocele+treatment+and+fertility+outcomes.">A review of varicocele treatment and fertility outcomes.</a> Hum Fertil (Camb). 25 (2), 209-216 (2020).</li><li>&#199;ayan, S., Akbay, E., Saylam, B., Kad&#305;o&#287;lu, A. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Effect+of+varicocele+and+its+treatment+on+testosterone+in+hypogonadal+men+with+varicocele:+Review+of+the+literature.">Effect of varicocele and its treatment on testosterone in hypogonadal men with varicocele: Review of the literature.</a> Balkan Med J. 37 (3), 121-124 (2020).</li><li>Ulusoy, O., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Successful+outcomes+in+adolescent+varicocele+treatment+with+high-level+laparoscopic+varicocelectomy.">Successful outcomes in adolescent varicocele treatment with high-level laparoscopic varicocelectomy.</a> J Pediatr Surg. 55 (8), 1610-1612 (2020).</li><li>Mehta, A., Goldstein, M. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Microsurgical+varicocelectomy:+A+review.">Microsurgical varicocelectomy: A review.</a> Asian J Androl. 15 (1), 56-60 (2013).</li><li>Marmar, J. L. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=The+evolution+and+refinements+of+varicocele+surgery.">The evolution and refinements of varicocele surgery.</a> Asian J Androl. 18 (2), 171-178 (2016).</li><li>Wang, X., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Prospective+comparison+of+local+anesthesia+with+general+or+spinal+anesthesia+in+patients+treated+with+microscopic+varicocelectomy.">Prospective comparison of local anesthesia with general or spinal anesthesia in patients treated with microscopic varicocelectomy.</a> J Clin Med. 11 (21), 6397 (2022).</li><li>Al-Kandari, A. M., Shabaan, H., Ibrahim, H. M., Elshebiny, Y. H., Shokeir, A. A. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Comparison+of+outcomes+of+different+varicocelectomy+techniques:+Open+inguinal,+laparoscopic,+and+subinguinal+microscopic+varicocelectomy:+A+randomized+clinical+trial.">Comparison of outcomes of different varicocelectomy techniques: Open inguinal, laparoscopic, and subinguinal microscopic varicocelectomy: A randomized clinical trial.</a> Urology. 69 (3), 417-420 (2007).</li></ol>

<table border="1" fo:keep-together.within-page="1" fo:keep-with-next.within-page="always">
	<tbody>
		<tr>
			<td>0.9% sodium chloride solution</td>
			<td>Guangdong Otsuka Pharmaceutical Co. LTD</td>
			<td>21M1204</td>
			<td>Preparation for injection of medication during surgery</td>
		</tr>
		<tr>
			<td>20 MHz Microvascular Doppler System</td>
			<td>Vascular Technology, Inc.</td>
			<td>102802</td>
			<td>Doppler ultrasound was used to identify the spermatic artery</td>
		</tr>
		<tr>
			<td>4-0 coated, Braided Silk</td>
			<td>Jiasheng Medical Products Co., Ltd</td>
			<td>1600-31</td>
			<td>Ligation of spermatic vein</td>
		</tr>
		<tr>
			<td>5-0 absorbable surgical suture</td>
			<td>HORCON</td>
			<td>MY313G4</td>
			<td>Skin and fascial suture</td>
		</tr>
		<tr>
			<td>6-0 absorbable surgical suture</td>
			<td>HORCON</td>
			<td>JE1264</td>
			<td>Deep tissue suturing</td>
		</tr>
		<tr>
			<td>Compound lidocaine cream</td>
			<td>Tongfang Pharmaceutical Group</td>
			<td>H20063466</td>
			<td>25mg of propacaine and 25mg of lidocaine per gram for epidermal infiltration anesthesia</td>
		</tr>
		<tr>
			<td>Dianerkang Iodophor Skin Disinfectant</td>
			<td>Shanghai Likang Disinfectant HI-Tech Co,Lid</td>
			<td>31005102</td>
			<td>For skin disinfection and the effective iodine content is from 4.5g/L-5.5g/L</td>
		</tr>
		<tr>
			<td>electrotome</td>
			<td>Shanghai Hutong Electronics Co., Ltd</td>
			<td>GD350-B</td>
			<td>Used to cut open the fascia layer</td>
		</tr>
		<tr>
			<td>Fosfomycin Trometamol Powder</td>
			<td>Shanxi C&#38;Y Pharmaceutical Group Co., Ltd.</td>
			<td>H19994124</td>
			<td>Oral antibiotics for infection prevention</td>
		</tr>
		<tr>
			<td>haemostatic forceps</td>
			<td>SHINVA</td>
			<td>ZH240RN</td>
			<td>Used in surgical procedures</td>
		</tr>
		<tr>
			<td>Lidocaine Hydrochloride Injection</td>
			<td>Shanghai Harvest Pharmaceutical Co., Ltd</td>
			<td>H20023777</td>
			<td>Mixed with Ropivocoine Hydrochloride injection for deep infiltration anesthesia</td>
		</tr>
		<tr>
			<td>methylene blue</td>
			<td>JUMPCAN</td>
			<td>H32025285</td>
			<td>Skin marker</td>
		</tr>
		<tr>
			<td>micro scissors</td>
			<td>SHINVA</td>
			<td>ZF123RN</td>
			<td>Used in surgical procedures</td>
		</tr>
		<tr>
			<td>micro tweezers</td>
			<td>SHINVA</td>
			<td>ZD274RN</td>
			<td>Used in surgical procedures</td>
		</tr>
		<tr>
			<td>needle holder</td>
			<td>SHINVA</td>
			<td>ZM234R/RN/RB</td>
			<td>Used in surgical procedures</td>
		</tr>
		<tr>
			<td>NeutroPhase</td>
			<td>NovaBay Pharmaceuticals,Inc</td>
			<td>CA 94608 USA</td>
			<td>Wound Cleanser</td>
		</tr>
		<tr>
			<td>ophthalmic scissors</td>
			<td>SHINVA</td>
			<td>ZC120R/RN/RB</td>
			<td>Used in surgical procedures</td>
		</tr>
		<tr>
			<td>Ropivocoine Hydrochloride injection</td>
			<td>Jiangsu Hengrui Pharmaceuticals Co., Ltd</td>
			<td>H20060137</td>
			<td>Mixed with Lidocaine Hydrochloride Injection for deep infiltration anesthesia</td>
		</tr>
		<tr>
			<td>Surgical Microscope</td>
			<td>Carl Zeiss Meditec AG</td>
			<td>20162224730</td>
			<td>for microscopic operations</td>
		</tr>
		<tr>
			<td>Titanium Clips</td>
			<td>WECK HORIZON</td>
			<td>002200</td>
			<td>used to clamp vena cava</td>
		</tr>
		<tr>
			<td>Titanium Clips</td>
			<td>WECK HORIZON</td>
			<td>005200</td>
			<td>used to clamp venule</td>
		</tr>
	</tbody>
</table>

microscopic varicocelectomy under local anesthesia as the treatment of varicocele

With the advancement of modern society, male infertility has gradually emerged as a global health issue, with varicocele being one of the predominant causes. The prevalence of varicocele is estimated at 15% in the general healthy population, 35% in those with primary infertility, and can be as high as 80% in the secondary infertility group1. Not only does varicocele lead to a decline in sperm count and quality2, but it also profoundly impacts the psychological well-being and quality of life of affected men.
Contemporary treatment modalities, such as microscopic varicocelectomy, have been widely adopted3,4. However, their limitations are becoming increasingly evident. Traditional microscopic varicocelectomy requires patients to undergo general anesthesia, which not only necessitates preoperative fasting and postoperative recovery inconveniences but also poses a significant challenge. The hemodynamic changes induced by anesthesia might obscure the pulsations of the spermatic artery, subsequently increasing the intricacy of isolating and preserving the vessel during the procedure5.
In light of these challenges, a method of performing microscopic varicocelectomy under local anesthesia was proposed and implemented. The salient advantage of this unique approach lies in its ability to swiftly and accurately pinpoint the pulsating spermatic artery, thus reducing the risk of injury to the vessel. Furthermore, local anesthesia offers a more patient-centric surgical experience, sidestepping the adverse effects of general anesthesia, and potentially reducing medical costs, presenting a more cost-effective and efficient treatment option. Additionally, considering the practical realities and clinical experiences in China, this innovative method proffers a fresh perspective in the treatment of varicocele and holds promise for broader clinical application. Through this research, a safer and more effective treatment alternative for patients would be provided, aiming to enhance their reproductive capabilities and overall quality of life.

<meta charset="utf8"></head><body>저자 스포트라이트: 향상된 수술 기법을 통한 정맥류 치료의 발전

정맥류의 치료로서 국소 마취하에 현미경적 정맥류절제술

Varicocele is linked to 35%to 40%of male infertility cases during reproductive years. The globally accepted approach for treating this condition is through a microscopic varicocelectomy conducted under general anesthesia. This protocol demonstrates this surgery using local anesthesia to improve patient comfort and reduce financial costs.This new one should significantly shorten the required surgery time and offers opportunities for patients who cannot undergo general anesthesia. Under local anesthesia, we can more clearly observe the positions of symptomatic arteriole, which helps us make more a precise resolution and protection. We will focus on the changes in the small non-encoding RNAs after the surgery, because many patients seem to improve after surgery but still cannot conceive naturally.Based on our preliminary research, we speculate that small non-encoding RNAs may play an important role in this process.

Varicocele, characterized by the dilation of veins within the spermatic cord, is a prevalent disease in males, accounting for 35%-40% of infertility cases ...

microscopic-varicocelectomy-under-local-anesthesia-as-treatment

Research

JoVE Journal

Medicine

Microscopic Varicocelectomy under Local Anesthesia as the Treatment of Varicocele

776 조회수.  Affiliated Hospital of Shanghai Institute for Biomedical and Pharmaceutical Technologies. 정맥류는 가임기 남성 불임 사례의 35%에서 40%와 관련이 있습니다. 이 질환을 치료하기 위해 전 세계적으로 인정받는 접근법은 전신 마취 하에 실시되는 현미경 정맥류 절제술을 사용하는 것입니다. 이 프로토콜은 환자의 편안함을 개선하고 재정적 비용을 줄이기 위해 국소 마취를 사용하는 이 수술을 보여줍니다.이 새로운 마취는 필요한 수술 ...