Robotic-Assisted Varicocelectomy

Abstract

Several theories have been proposed to explain the observed pathophysiology of varicoceles. Semen quality uniformly declines in animals with induced varicoceles, even when there is only a left varicocele. The reduction in scrotal temperature after varicocele ligation supports a causative role of increased temperature on the infertility produced by varicocele. It has been hypothesized that varicoceles cause hypoxia, which might play a role in altering ­spermatogenesis in the varicocele patients. A higher frequency of sperm cells with fragmented DNA has been reported in the ejaculate of subjects with varicocele, in comparison with fertile donors, a phenomenon that might be correlated with an increase in reactive oxygen species. Numerous studies have reported the significant benefits on semen parameters with surgical treatment of varicocele. Currently, there are several surgical approaches available for the treatment of varicocele, including the retroperitoneal approach, (high ligation via open, laparoscopic, retroperitoneoscopic, single-incision laparoscopic, or robotic-assisted), the inguinal approach (open), and the subinguinal approach (open microscopic). Of these approaches, the subinguinal microscopic approach offers the best outcomes, including shorter hospital stays, preservation of the testicular arteries and lymphatics, least number of postoperative complications, recurrence, and a higher number of pregnancies. The microscopic assistance, however, takes longer time to perform due to surgeons who are unaccustomed to use microinstruments, two-dimensional vision, and inability to see their own hands.