<meta charset="utf8"></head><body>Lokal Anestezi Altında Mikrocerrahi Varikosel Çıkarılması

<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>Yazar Spotlight: Gelişmiş Cerrahi Tekniklerle Varikosel Tedavisini İlerletmek

Varikosel Tedavisi Olarak Lokal Anestezi Altında Mikroskobik Varikoselektomi

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

877 Görüntüleme.  Affiliated Hospital of Shanghai Institute for Biomedical and Pharmaceutical Technologies. Varikosel, üreme yıllarında erkek infertilite vakalarının %35 ila %40'ı ile bağlantılıdır. Bu durumu tedavi etmek için dünya çapında kabul edilen yaklaşım, genel anestezi altında yapılan mikroskobik varikoselektomidir. Bu protokol, hasta konforunu artırmak ve finansal maliyetleri azaltmak için lokal anestezi kullanılarak yapılan bu ameliyatı göstermektedir.Bu yeni ameliyat, gerekli ameliyat süresini önemli ölçüde kısaltmal...

Video: Yazar Spotlight: Gelişmiş Cerrahi Tekniklerle Varikosel Tedavisini İlerletmek

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.

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.