Document Detail


Microsurgical Subinguinal Varicocelectomy in Children, Adolescents and adults: Surgical anatomy and Anatomically Justified Technique.
MedLine Citation:
PMID:  21835913     Owner:  NLM     Status:  Publisher    
Abstract/OtherAbstract:
Microsurgical varicocelectomy has become the gold standard in adults, because of low recurrence and postoperative hydrocele rates; it is increasingly applied in children and adolescents. This review aims to provide the surgeon with the necessary surgical anatomy of the spermatic cord, and with a step-by-step, anatomically justified description of technique, toward clearer comprehension and improved application. The anatomical compartments of the spermatic cord are delineated by the external and internal spermatic fasciae. Venous drainage of testis-epididymis is accomplished by the internal spermatic, deferential and external spermatic (cremasteric) veins. All three anastomose at the caudal pole of testis, and then via gubernacular veins with the posterior scrotal veins. Another anastomosis exists between a cremasteric branch and anterior scrotal veins, which gives the external pudendal vein. Subinguinal approach offers access to varicose spermatic veins and collaterals. Use of surgical microscope offers identification of small veins, preservation of arteries, lymphatics, nerves, and appreciation of spermatic cord fasciae which permits development of two surgical planes. In the surgical plane of internal spermatic vessels, internal spermatic veins are ligated while the testicular artery and innervation, as well as lymphatics are preserved. In the plane of cremasteric vessels and vas, cremasteric veins are ligated, while the cremasteric artery, vas deferens and its vasculature, lymphatics and the genital branch of genitofemoral nerve are preserved. Delivery of the testis to ligate gubernacular veins is at the discretion of the surgeon. Finally, venous return is effected by deferential and scrotal veins, or when gubernacular veins are ligated, by deferential veins only.
Authors:
Petros Mirilas; Anastasia Mentessidou
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Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2011-8-11
Journal Detail:
Title:  Journal of andrology     Volume:  -     ISSN:  1939-4640     ISO Abbreviation:  -     Publication Date:  2011 Aug 
Date Detail:
Created Date:  2011-8-12     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  8106453     Medline TA:  J Androl     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
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