Single port varicocelectomy using SILS™ multiple access port
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doi: 10.1590/S1677-5538.IBJU.2015.02.32

Hoon Choi 1, Jae Hyun Bae 1

1 Department of Urology, Korea University Ansan Hospital, Korea University College of Medicine, 123 Jeokgeum-ro, Danwon-gu, Ansan 425-707, Korea

ABSTRACT

Purpose: Several surgical approaches have been used for varicocelectomy. We report single port varicocelectomy using SILS™ (Covidien, Norwalk, CT) multiple access port.
Case : The greade III varicocele patient was 23 years old and placed in supine position. About 2 cm vertical skin incision was made in a crease just lateral to the umbilicus and  SILS™ port was placed with three 5-mm trocars. Incision to posterior peritoneum from the point 3 cm superior to the internal inguinal was made by needle holder with a broken 15th blade tip. The testicular vessels were exposed. The lymphatic vessels and testicular artery were identified and separated from the testicular vein with flexible laparoscopic instruments and conventional rigid instruments. Three testicular veins were clipped with hemoclips (EndoClip , Autosuture, Norwalk, CT). Posterior peritoneum was repaired with 4-0 vicryl with one side of 5 mm Hem-o-lok clip (Weck Research,Triangle Park, NC). Than the distal end of suture site was also closed with Hem-o-lok.
Results : The whole procedure was completed with no complication. The operative time was 85 minutes, and blood loss was minimal. The patient was discharged 2 days after the operation. Left scrotal pain and vein engorgement was disappeared.
Conclusions: Our single port varicocelectomy method is a safe and effective alternative to conventional method. This will provide minimally invasive surgical option for varicocele and we can expect more potential cosmetic benefit and less morbid.

ARTICLE INFO Available at: www.brazjurol.com.br/videos/march_april_2015/Choi_395_396Video.htm
Int Braz J Urol. 2015; 41 (Video #2): 395-6

 

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Submitted for publication:
January 10, 2015

 

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Accepted after revision:
February 20, 2015

 

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Correspondence address:
Jae Hyun Bae, MD
Department of Urology
Korea University Hospital
Korea University College of Medicine
123 Jeokgeum-ro, Danwon-gu
Ansan 425-707, Korea
Fax: + 82 31 412-5194
E-mail: doc71377@naver.com

Editorial Comment

This video demonstrates the incredible versatility of single port laparascopy, and its implementation in the management in varicoceles.  It allows the patient a quicker recovery, while still providing resolution of the pathology.  We applaud the authors for their novel and innovative way of managing a very common urologic problem seen by most Urologists.  With further improvement in the technology of minimally invasive therapies, the management of many more urologic diseases will become easier and hopefully more efficient and precise. 

Daniel R. Martinez, MD
Clinical Instructor
Sexual Medicine Fellow
Department of Urology
Morsani College of Medicine, University of South Florida, USA
E-mail: dmartine@health.usf.edu