Name: microscopic cyst resection for the treatment of patients diagnosed with epididymal cyst
Uploaded: 2023-03-31T13:20:00.000+00:00
Duration: 3 min 10 s
Description: Watch this Scientific Journal Video about Microscopic Cyst Resection for the Treatment of Patients Diagnosed with Epididymal Cyst at JoVE.com

This study was supported by health science and technology projects in Yunnan Province (NO.2018NS0256) and training objects of medical subject leaders in Yunnan Province (NO. D-2018039)

We performed retrospective analysis of the clinical data of male patients, initially diagnosed with epididymal cysts, admitted to the urology inpatient department of the Affiliated Hospital of Kunming University of Technology (the First People&#39;s Hospital of Yunnan Province). Written, informed consent must be obtained from patients before surgery.
1. Clinical inclusion and exclusion criteria
<ol>
	<li>Include patients who are below 45 years of age and have a need to preserve fertility. 
	&#8203;NOTE: The patient in this study was younger than 45 years old.</li>
	<li>Include patients with a clinician&#39;s preliminary diagnosis of epididymal cystic occupancy following examination with type-B ultrasound or computer tomography (CT) imaging.</li>
	<li>Exclude any patients with severe cardiopulmonary dysfunction, obvious sexual dysfunction, or anaspermia. Exclude patients with a testicular mass, epididymal tuberculosis, and patients who have difficulty to determine the relationship between the testis and the neoplasm.</li>
</ol>
2. Patient preparation
<ol>
	<li>After performing the relevant examination and active preoperative preparation, fully explain the relevant conditions, surgical plans, and related risks.</li>
	<li>Discuss with the patient and his family members the patient&#39;s condition, surgical plan, selection, and possible risks and complications. Obtain consent from the patient and his family members for testicular and epididymal exploration and microscopic cyst resection.</li>
	<li>Instruments for operation
	<ol>
		<li>Make sure that a surgical microscope and microsurgical instruments are available.</li>
	</ol>
	</li>
	<li>Preparation for operation
	<ol>
		<li>Clean and shave the inguinal/subinguinal skin and scrotum before surgery.</li>
		<li>The surgical site need not be sterilized before surgery. As a routine procedure, clean the scrotum with soap and shave the surgical area using a razor.</li>
		<li>Place the patient on the operating table in a supine position after general anesthesia. 
		&#8203;NOTE: Anesthesia is provided by the anesthetist. The anesthetist chooses the anesthetic agent and the dosage to be used.</li>
	</ol>
	</li>
</ol>
3. Procedure
<ol>
	<li>Expose and explore the testis and epididymis in the incision.
	<ol>
		<li>Perform a 2.5-3 cm scrotal skin incision with a surgical knife. Cut the scrotal flesh membrane and testicular sheath membrane layer by layer with an electric knife.</li>
		<li>Carefully explore the testis and epididymis to find and confirm the epididymal cyst. Change/stop the surgical plan if solid epididymal tumors or masses derived from the testis are found.</li>
		<li>Lift the epididymis out of the incision. Find the epididymal cyst.</li>
	</ol>
	</li>
	<li>Microscopic cyst resection
	<ol>
		<li>Bring an operating microscope into the operating field and examine the cord under a 6x-10x power magnification.</li>
		<li>Use an electric knife to cut the epididymal capsule at the base of the epididymal cyst and normal epididymal tissue. Open up the epididymal capsule carefully and avoid opening the epididymal cyst cavity (see Figure 1).</li>
		<li>Carefully explore the space between the epididymal cyst wall and the epididymal tissue (epididymal tubule). Based on this anatomical level, gradually microseparate the epididymal cyst along the cyst wall with microscissors and microscopic forceps. Carefully isolate the epididymal tissue (epididymal tubule) surrounding the epididymal cyst to the base of the epididymal cyst (see Figure 2).</li>
		<li>Microseparate the epididymal cyst from its base and the gap between the cyst and normal epididymal tissue. Excise the epididymal cyst from the base with microscissors or an electric knife after occlusion of the epididymal tissue with a microvascular clamp or ligation by a microsuture (7-0 or 6-0) (see Figure 3).</li>
		<li>Carefully dissect the separation and avoid epididymal cyst wall breakage, especially on blood epididymal cysts (see Figure 4) or large epididymal cysts with clear cystic fluid inside (see Figure 5). If the cyst wall is damaged, carefully clamp the breach with microvascular forceps to avoid fluid overflow in the cyst. Remove the epididymal cyst completely and preserve the noninvasive epididymal tubular patency as much as possible.</li>
	</ol>
	</li>
</ol>
4. Finish the operation
<ol>
	<li>Carefully perform micro hemostasis. Stitch the incisions on the epididymal capsule and periorchium in layers. Then suture the scrotal wound.</li>
	<li>Send the mass (cyst) to the pathology department for pathological examination.</li>
	<li>Leave the patients in bed for 1 day after surgery and discharge them 1-3 days after the surgery.</li>
</ol>
5. Postoperative follow-up
NOTE: The postoperative follow-up lasts for 3-50 months. Conduct the below tests/examinations in the follow-up.
<ol>
	<li>Check the patient for scrotal swelling, pain, and other clinical symptoms after surgery.</li>
	<li>Perform a detailed physical examination, Including checking the scrotal wound, testis, and epididymis.</li>
	<li>Perform type-B ultrasound examination on the testis and epididymis.</li>
</ol>

<ol>
	<li>Jelloul, L., Billerey, C., Ait Ali Slimane, M., Mboyo, A., Aubert, D. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Epididymal+cysts+in+adolescents.">Epididymal cysts in adolescents.</a> Annales d'Urologie. 33 (2), 104-108 (1999).</li><li>Boscarelli, A., Bellini, T. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Epididymal+cyst+in+children.">Epididymal cyst in children.</a> European Journal of Pediatrics. 180 (9), 2723-2729 (2021).</li><li>Yong-Bao, W., 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=The+efficacy+and+safety+of+scrotoscope+in+the+treatment+of+masses+in+caput+epididymidis.">The efficacy and safety of scrotoscope in the treatment of masses in caput epididymidis.</a> Journal of Trauma and Emergency Surgery. 6 (4), 208-211 (2018).</li><li>Erikci, V., 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=Management+of+epididymal+cysts+in+childhood.">Management of epididymal cysts in childhood.</a> Journal of Pediatric Surgery. 48 (10), 2153-2156 (2013).</li><li>Zhen-Chao, L., Xing-You, Q., Rong-De, T. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Diagnosis+value+of+high+frequency+color+doppler+ultrasound+for+epididymis+cyst.">Diagnosis value of high frequency color doppler ultrasound for epididymis cyst.</a> China Modern Medicine. 20 (3), 102-103 (2013).</li><li>Sinha, V., Shankar, M., Sardana, N., Aggarwal, R. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=A+rare+case+of+epididymal+cyst+due+to+schistosomiasis.">A rare case of epididymal cyst due to schistosomiasis.</a> Cureus. 11 (9), e5755 (2019).</li><li>Mukendi, A. M. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Bilateral+spontaneous+resolution.">Bilateral spontaneous resolution.</a> Clinical Case Reports. 8 (12), 2689-2691 (2020).</li><li>Patoulias, D., Kalogirou, M., Patoulias, I. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Intraparenchymal+4+cm+in+diameter+in+a+15-year+old+male+patient;+a+case+report+and+review+of+the+literature.">Intraparenchymal 4 cm in diameter in a 15-year old male patient; a case report and review of the literature.</a> Acta Medica. 59 (4), 137-139 (2016).</li><li>Sun-Biao, L., Meng, L. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Clinical+analysis+of+43+epididymal+mass+patients.">Clinical analysis of 43 epididymal mass patients.</a> Fujian Medical Journal. 31 (3), 32-33 (2009).</li><li>Wang, 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=Treatment+for+childhood+herniorrhaphy.">Treatment for childhood herniorrhaphy.</a> Urology. 112, 80-84 (2018).</li><li>Ory, 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=Predictors+of+success+after+bilateral+during+vasectomy+reversal:+A+multi-institutional+analysis.">Predictors of success after bilateral during vasectomy reversal: A multi-institutional analysis.</a> Canadian Urological Association Journal. 16 (3), E132-E136 (2022).</li></ol>

The authors have nothing to disclose.

As we mentioned previously, epididymal cysts mostly occur in men aged 20 to 40 years, while there is also some literature on epididymal cysts in childhood1,2. To date, the cause of epididymal cysts is not clear, and there is no specific medicine for its treatment. In addition to a few reports that epididymal cysts can resolve spontaneously without surgery7, most epididymal cysts, although their progression and enlargement are relatively sl...

Epididymal cysts mostly occur in men aged 20-40 years old, although some literature also exists concerning epididymal cysts in childhood1,2. Previous reports have covered concerns about surgical destruction and postoperative scarring in patients undertaking nonmicroscopic epididymal cyst resection or epididymal resection3,4. Other postoperative complexes include seminal tract obstruction, immune infertility, and testicular atrophy. There is also a higher risk for postoperative occurrence, and even recurrence, of hematoma, edema, and a sustaining pain and cyst5,6. There are also reports that epididymal cysts can resolve spontaneously without surgery7. As a result, previous studies have concluded that epididymal cysts do not lead to testicular network expansion without intervention, and puncture or surgical treatment can be considered if epididymal cysts combine with testicular network expansion or damage of the proximal vas deferens2,4. Further, some investigators believe that patients with large epididymal cysts combined with pain are also suitable for surgical resection8. The treatment of epididymal cysts by puncture alone is prone to relapse. Traditional (nonmicroscopic) cyst resection or epididymectomy may destroy the epididymal canal, leading to epididymal obstruction, immune infertility, or even testicular atrophy; therefore, one should be cautious for young patients with fertility requirements2,9. Patients with childbirth plans are recommended to choose traditional (nonmicroscopic) epididymal cyst surgery as a cautionary measure. 
Microsurgical methods have been widely used in the treatment of vas deferens obstruction and epididymal obstruction, with excellent results10,11. The treatment of male epididymal cysts via microtechnology may be a beneficial option, however the necessity of extending microtechnology treatment to male epididymal cysts is questionable. We took the lead in carrying out microscopic epididymal exploration and cyst resection surgery in China. We carried out retrospective analysis of the clinical data of male patients, initially diagnosed with epididymal cysts, admitted to the urology inpatient department of the Affiliated Hospital of Kunming University of Technology (the First People's Hospital of Yunnan Province) between September 2017 and April 2019. The patients were younger than 45 years old and required fertility preservation. Based on microscopic manipulation, which largely improved visualization of the subtle tissue structures of the epididymis, the cyst could be clearly dissected apart and completely removed intact.

<table><tbody><tr><td>Ablation electrode</td><td>Baisheng Medical Devices Co., Ltd. China</td><td>OBS-Db</td><td></td></tr><tr><td>Anesthesia apparatus</td><td>Datex-Ohmeda,Inc.USA</td><td>Aespire View, Datex-Ohmeda</td><td></td></tr><tr><td>Compact Anesthesia Monitor</td><td>GE Healthcare Finland OY.Finland</td><td>S/5 Compact</td><td></td></tr><tr><td>&amp;nbsp;Electric knife</td><td>Valleylab.USA</td><td>Valleylab Force FX-8C</td><td></td></tr><tr><td>Surgical (operation) microscope</td><td>Lecia Microsysterms (Schweiz) AG. Germany</td><td>Lecia M525 F20</td><td></td></tr></tbody></table>

microscopic cyst resection for the treatment of patients diagnosed with epididymal cyst

Epididymal cysts mostly occur in men aged 20-40 years old. Previous reports have covered concerns about postoperative complexes, including postoperative asoedema, hematoma, sustaining pain, and seminal tract obstruction in patients who have undertaken nonmicroscopic epididymal cyst resection or epididymal resection. Nonmicroscopic epididymal cyst surgery is suggested for patients with childbirth plans as a precaution. The treatment of male epididymal cysts via microtechnology is obviously a beneficial option; we took the lead in carrying out microscopic epididymal exploration and cyst resection surgery in China. From September 2017 to April 2021, 41 young and middle-aged male patients diagnosed with epididymal cysts underwent microtechnology treatment in a program titled &#34;microscopic epididymal exploration and cystectomy&#34;. The postoperative follow-up lasted for 3-50 months. The results confirmed that, as microscopic manipulation largely improved visualization of the subtle tissue structures of the epididymis, the cyst could be clearly dissected apart and completely removed intact under the microscope. Bleeding during the operation was significantly reduced (2-3 mL) and wound drainage was not required. According to follow-up data, microscopic treatment significantly reduced the incidence of postoperative scrotal hematoma, edema, and long-term postoperative pain, thereby promising a higher surgical success rate as well as recurrence prevention. Besides, preliminary experience and reflection suggest that microscopic epididymal exploration and cystectomy provide efficient preservation of the epididymal patency through refined treatment, while a better prognosis can be achieved. We recommend that surgery be carried out before the epididymal cyst develops to 0.8 cm in diameter, for fear that a larger epididymal cyst (&#62;0.9 cm in diameter) could cause the complete destruction of all tubules of the ipsilateral epididymis - a more severe case with damage to the testicular output network.

From September 2017 to April 2021, 41 young and middle-aged male patients diagnosed with epididymal cysts underwent microtechnology treatment in a program titled "microscopic epididymal exploration and cystectomy."
Here, we show the data from a single patient as a representative example. The patient was operated on for descending surgery (testicular and epididymal exploration and microscopic cyst removal) under general anesthesia. A scrotal incision was made, the testicular sheath was cut, the...

Watch this Scientific Journal Video about Microscopic Cyst Resection for the Treatment of Patients Diagnosed with Epididymal Cyst at JoVE.com

Microscopic Cyst Resection for the Treatment of Patients Diagnosed with Epididymal Cyst

Here, we present a protocol to treat patients diagnosed with an epididymal cyst using microscopic cyst resection. Based on microscopic manipulation, a largely improved visualization of the subtle tissue structures of the epididymis was obtained, so the cyst could be clearly dissected apart and completely removed intact.

Epididymal cysts mostly occur in men aged 20-40 years old. Previous reports have covered concerns about postoperative complexes, including postoperative ...

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7.6K Views.  The First People’s Hospital of Yunnan Province (Medical College of Kunming University of Science and Technology). Here, we present a protocol to treat patients diagnosed with an epididymal cyst using microscopic cyst resection. Based on microscopic manipulation, a largely improved visualization of the subtle tissue structures of the epididymis was obtained, so the cyst could be clearly dissected apart and completely removed intact.

Video: Microscopic Cyst Resection for the Treatment of Patients Diagnosed with Epididymal Cyst

Introduction of Intracapsular Rotary-cut Procedures (IRCP): A Modified Hysteromyomectomy Procedures Facilitating Fertility Preservation

Uterine fibroids are common benign tumors in the female reproductive system. A hysterectomy is the most effective treatment for symptomatic fibroids. For patients desiring pregnancy, laparoscopic intracapsular myomectomy (LM) is an alternative surgery option. Although LM is widely accepted to treat fibroids, it is technically demanding with risk of excessive bleeding and difficult suturing, especially in cases with large fibroids or tumors in unusual locations. Therefore, we developed an intracapsular rotary-cut procedure (IRCP) as a modification of laparoscopic intracapsular myomectomy, with the intention to minimize risks of LM and help uterine healing. A summary of the improvements to the IRCP is described: 1) making an incision at the site of the fibroid with a length of one-third to one-half of the fibroid&#39;s diameter at a depth reaching the fibroid&#39;s surface; 2) holding the fibroid stably and making rotary cuts on the fibroid at a depth of 0.5&#8211;1 cm within its pseudo-capsule while pulling it outward slightly, making sure not to cut off any pieces of the fibroid; and 3) repeating the cutting-and-pulling until the longest dimension of the fibroid is outside the incision. The multiple cuts are to minimize the diameter and extend the length of the fibroid. When the multiple cuts cause half of the fibroid body to &#34;shrink&#34;, the fibroid is squeezed out by contraction of the surrounding myometrium. Evaluation of the outcomes of IRCP showed that the time of enucleation and suturing, intraoperative bleeding, and decline of hemoglobin were significantly lower in the IRCP group than the LM group. As for reproductive outcomes, the full-term live birth rate of the IRCP group was significantly higher than that of LM group. However, there was no difference in delivery modes between the two groups. In conclusion, IRCP significantly benefits fertility preservation by minimizing damage to the uterus, protecting myofibers of the pseudo-capsule, and resulting in a shallower residual cavity, which eases stitching and causes less bleeding. It is worthwhile to adopt IRCP in younger patients who desire preservation of their fertility.

Introduction of Intracapsular Rotary-cut Procedures IRCP: A Modified Hysteromyomectomy Procedures Facilitating Fertility Preservation

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Fertility Sparing Procedure using Carbon Dioxide Fiber Laser Vaporization of Ovarian Endometrioma

The surgical management of endometrioma is still a matter of debate. Cystectomy, which is recognized as the standard technique, seems to be associated with a potential reduction in the ovarian reserve due to the inadvertent removal and thermal damage of healthy ovarian tissue. New ablative techniques with reduced tissue penetration depth and less thermal spread to the surrounding parenchyma may represent a viable alternative to cystectomy. For these reasons, the aim of this manuscript is to demonstrate the ablation of the endometrioma capsule using a CO2 fiber laser technique and discuss the clinical outcomes. Once the cyst has been drained and washed, a biopsy is taken. After cyst eversion, vaporization of the inner surface of the cyst is performed using a CO2 fiber laser. The technique is simple and reproducible as even young surgeons without any surgical experience were more confident in performing laser CO2 vaporization instead of cystectomy. The positive effects of CO2 technology are reported in a randomized controlled trial, where the postoperative changes in the antral follicular count (AFC) and antimullerian hormone (AMH) levels were compared between patients who had their endometrioma excised (cystectomy) and those who had undergone endometrioma vaporization with CO2 laser. The patients treated with CO2 laser showed significantly increased AFC without a reduction in serum AMH levels as compared to the cystectomy group, in which both parameters were significantly reduced. The postoperative pregnancy rate was also assessed, and comparable pregnancy rates were found after both treatments. On the contrary, patients treated with the CO2 fiber laser technique had more favorable in-vitro fertilization (IVF) outcomes compared to cystectomy.
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The surgical management of endometrioma is still a matter of debate. Cystectomy, which is recognized as the standard technique, seems to be associated ...

Microscopic Replantation of Penile Glans Amputation Due to Circumcision

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Cruciate ligament cysts of the knee are a rare condition. Posterior cruciate ligament cysts of the knee are less common than anterior cruciate ligament cysts. In patients with asymptomatic isolated cruciate ligament cysts of the knee, conservative treatment is recommended. Symptomatic cruciate ligament cysts of the knee are mostly manifested as knee hyperflexion pain, straightening pain, knee discomfort after standing for a long time or walking for a long time, etc., which seriously affects the quality of life, surgical treatment can be performed. The surgical treatments can be divided into ultrasound-guided cyst puncture and fluid extraction procedure and arthroscopic cystectomy. Cysts are mostly lobulated with a multi-layer cyst wall, cyst fluid extraction does not remove the cyst wall completely but simply extracts cyst fluid, leading to a high recurrence rate. Arthroscopic surgery can completely remove the cyst wall with little trauma, a low recurrence rate, and fast postoperative recovery, so arthroscopic resection is the most common and preferred method of treatment. Since posterior cruciate ligament cysts mostly occur posterior to the ligament, we remove the cyst wall by adding a double posteromedial approach to the knee joint, and the cyst wall is removed under direct vision, which is simple to operate, the cyst wall is completely cleared, the trauma is small, the postoperative recovery is fast, and there is no recurrence. Here, 8 posterior cruciate ligament cysts were removed with complete postoperative symptom relief, no surgical complications, and no recurrence at 1-year follow-up.

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Seminal Vesiculoscope Laser-Assisted Surgery to Treat Ejaculatory Duct Blockage

Treatment of Ejaculatory Duct Obstruction by Seminal Vesiculoscopy Assisted Flow Modification

Transurethral resection of ejaculatory duct (TURED) is a primary surgical approach to treat ejaculatory duct obstruction (EDO) caused by the ejaculatory duct cyst. Intraoperative excision of the verumontanum is usually required to expose the ejaculatory ducts. However, preserving the verumontanum structure allows for a better simulation of normal physiological anatomy. Maintaining the verumontanum may increase the risk of postoperative distal ejaculatory duct scarring, leading to recurrent obstruction or reduced semen volume. Therefore, we attempted a novel technique that preserves the verumontanum, which is relatively easier and safer compared to TURED. The following were the procedural steps: 1. A 6F seminal vesiculoscope was introduced through the external urethral orifice to the vicinity of the verumontanum, locating the opening of the affected-side ejaculatory duct and introducing a guidewire into the cyst. This successful step preserved the verumontanum, maximizing the retention of the anti-reflux mechanism in the distal ejaculatory duct. 2. The holmium laser enlarged the affected-side ejaculatory duct opening to 5 mm, decreasing the likelihood of postoperative closure of the ejaculatory duct opening and simplifying the procedure. 3. A window was created within the cyst to access the contralateral seminal vesicle, and then a holmium laser was used to burn and dilate the opening to 5 mm, redirecting the contralateral ejaculatory duct into the cystic cavity. This modification preserved the opening of the healthy-side ejaculatory duct and provided a new outflow passage for semen, reducing the risk of decreased semen volume postoperatively. The patients experienced no complications postoperatively, had shorter hospital stays, and showed improvement in semen volume. Hence, this surgical approach is simple yet effective.

Author Spotlight: Advanced Treatment of Seminal Duct Blockage Employing Endoscopy-Mediated Semen Channel Refluviation 

This protocol introduces the clinical application of seminal vesicle endoscopy combined with holmium laser in the treatment of ejaculatory duct obstruction caused by ejaculatory duct cyst.

Transurethral resection of ejaculatory duct (TURED) is a primary surgical approach to treat ejaculatory duct obstruction (EDO) caused by the ejaculatory ...

Microsurgical Varicocele Removal Under Local Anesthesia

Microscopic Varicocelectomy under Local Anesthesia as the Treatment of Varicocele

Varicocele, characterized by the dilation of veins within the spermatic cord, is a prevalent disease in males, accounting for 35%-40% of infertility cases among men of reproductive age. This condition may disrupt normal neuroregulation, blood supply, and temperature regulation in the testicles, thereby impacting sperm count, quality (morphology, fragmentation rate), and functionality (motility). It may even induce symptoms such as pain and testicular atrophy. The international standard treatment method is microscopic varicocelectomy, typically performed under general anesthesia. This requires patients to fast before surgery and necessitates recovery and fasting care postoperatively. The arterial blood pressure drop caused by anesthesia may obscure the fluctuation of the spermatic artery, making the precise intraoperative isolation and protection of the spermatic artery more challenging. Therefore, this study proposes and implements microscopic varicocelectomy under local anesthesia. This method facilitates rapid and precise identification of the fluctuating spermatic artery, reducing the risk of spermatic artery damage. It also provides more humane care for patients, reduces economic burden, and offers a new perspective on the treatment of varicocele.

Author Spotlight: Advancing Varicocele Treatment Through Enhanced Surgical Techniques

Varicocele accounts for 35%-40% of infertility cases among men of reproductive age. The international standard treatment method is microscopic varicocelectomy, typically performed under general anesthesia. This study proposes and implements microscopic varicocelectomy under local anesthesia, which provides more humane care for patients and reduces the economic burden.

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