Laparoendoscopic single-site surgery versus conventional laparoscopic varicocele ligation in men with palpable varicocele: A randomized, clinical study

Abstract

Objective This study was designed to compare the outcomes of two different surgical techniques: conventional transperitoneal laparoscopic varicocele ligation (CTL-VL), and laparoendoscopic single-site varicocele ligation (LESS-VL), using transumbilical home-made single port device. Methods Our sample included 82 male patients with 92 clinically palpable varicoceles who underwent varicocelectomy. The patients were randomly allocated to one of two groups according to varicocele ligation technique. Early postoperative complications, hospital stay, time to return to work, degree of satisfaction, and semen parameters were assessed. A visual analogue scale (VAS) pain score that ranged from 0 to 10 and analgesia requirements during the postoperative course were used to evaluate postoperative pain. Results The operating room time and hospital stay of the two study groups were comparable, but time to return to normal activity was significantly shorter in the LESS group compared with the CTL group (P = 0.025). Both VAS and the postoperative use of analgesics were significantly lower during postoperative days 2 (P = 0.005) and 3 (P = 0.047) in patients who underwent LESS-VL compared with patients who underwent CTL-VL. Significant improvements in sperm count, motility, and morphology were observed in both groups (P < 0.001; at each of the variables in both groups), but the proportion of patients who showed improvement was not significantly different between the two groups. Conclusions This relatively small-scale study suggests that LESS-VL is a safe and effective alternative to CTL-VL that provides surgeons with a minimally invasive surgical option and the ability to hide the surgical incision within the umbilicus.