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    Varicocelectomy: Microscopic subinguinal (Marmar) technique

    James M. Hotaling, MD, MSJames M. Hotaling, MD, MS Thomas Walsh, MDThomas Walsh, MD Joseph Alukal, MDCommentary by Joseph Alukal, MD

    Section Editor James M. Hotaling, MD, MS, is assistant professor of surgery (urology) at the Center for Reconstructive Urology and Men's Health, and Dr. Walsh is associate professor of urology at the University of Washington, medical director of the UW Male Fertility Laboratory, and founding director of The UW Men’s Health Center, Seattle.


    Section Editor’s note: ‘Y’tube, a new video section of UrologyTimes.com, is a resource for urologists and other clinicians who focus on men’s health. ‘Y’tube covers surgical aspects of a variety of men’s health issues with the ultimate goal of accumulating a library of videos to serve as a reference. Here, three leading groups demonstrate varicocelectomy techniques. All make use of a microdoppler and delicate dissection to identify, isolate, and preserve the testicular artery. Two of the videos demonstrate the subinguinal approach to the varicocele. We have found this to result in less pain and quicker recovery for patients. The third video demonstrates a single-port approach to a laparoscopic varicocelectomy and use of a microdoppler in the laparoscopic setting.

    This video demonstrates a subinguinal microscopic varicocelectomy without delivery of the testis. It demonstrates excellent microsurgical technique and the exposure that can be obtained through a well-placed incision. It also illustrates the equipment necessary to render an optimal surgical outcome.


    Dr. Alukal: The video by Drs. Walsh and Hotaling emphasizes the relevant anatomy of the cord structures involved and includes a number of useful surgical tips and tricks. Delivery of the testis is not performed; external spermatic veins are identified behind the cord and divided there. The microscopic Doppler (3-mm tip, 20 MHz) is again employed and is a very useful tool.

    More varicocelectomy videos:

    Varicocelectomy: Microsurgical, subinguinal technique

    Varicocelectomy: Single-port laparoscopic technique

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