Is There Any Role for Intraoperative Ultrasound During Varicocele Repair

Doppler ultrasound assistance has been part of the surgical treatment of varicocele for the past decades. The development of microscopic subinguinal varicocelectomy has provided the surgical management of varicocele with precision, by facilitating less postoperative pain and shorter time for recovery and lower rates of complications and recurrence. Nevertheless, vascular anatomy of the subinguinal access represents a challenge and contributes to the technical difficulty of this approach. Branching of the testicular artery is usually seen at the subinguinal level, and the small spermatic arteries are frequently surrounded by a dense complex of adherent veins, requiring special attention of the surgeons. Optical magnification, precise microsurgery skills, and vascular Doppler have been used at this point to achieve maximal preservation of the arterial blood supply to the testes and to aid in the identification of cord structures. Doppler ultrasound represents a major assistance in preserving testicular arterial inflow and may allow a larger number of veins to be identified and ligated. The clinical implication of these findings can be supported by recent studies showing a significant correlation between the total number of veins ligated and the improvements in total sperm motility and sperm concentration.