Background and Objective: Many papers reported that
microsurgical varicocelectomy was among the best treatment
modalities for varicocele. However, the difference of intraoperative
anatomic detail between macroscopic and microsurgical varicocele
repair in the same spermatic cord has not been well discussed.
Methods: Between August 2010 and February 2011, 32 men
with 42 sides grade 2-3 varicocele were enrolled in this study.
One surgeon firstly mimicked the modified open varicocelectomy
by identifying, isolating, and marking the presumed internal
spermatic veins, lymphatics and arteries. Another surgeon then
checked the same spermatic cord using operating microscope to
investigate the number of missed veins, to be ligated lymphatics
and arteries in the "imitative" open varicoceletomy.
Results: There were significant differences in the average
number of internal spermatic artery (1.67 vs. 0.91), internal
spermatic vein (6.45 vs. 4.31) and lymphatic (2.93 vs. 1.17)
between microscopic and macroscopic procedures (all P<0.001).
Meanwhile, an average of (2.14±1.26) internal spermatic veins
were missed, among them (1.63±1.32) internal spermatic veins
adherent to the preserved testicular artery were overlooked. The
number of (0.69±0.84) lymphatics and (0.74±0.74) arteries
were to be ligated in "macroscopic varicocelectomy". A number
of (1.07 ±1.11) lymphatics were neither identified nor ligated.
In addition, in 2 cases the vasal vessels were to be ligated at
Conclusions: Microsurgical varicocelectomy can preserve more
internal spermatic artery and lymphatic tissue and ligate more veins.