Microsurgical Correction of Varicocele with Aid of a 20 MHz vascular MicroDoppler

G. M. Paul, J. E. Rios Rodriguez

Varicocele; Microsurgery; Micro-Doppler; Male Infertility; Spermatic Cord; Arterial Preservation

This work demonstrates the use of intraoperative micro-Doppler ultrasound during microsurgical varicocelectomy, emphasizing its role in improving differentiation of internal and external spermatic vessels, increasing arterial preservation, and reducing operative time. We believe this contribution will be of significant interest to your readership, given the relevance of varicocele management in male infertility and microsurgical practice.

Background: Varicocele is a prevalent and potentially correctable cause of male infertility. Microsurgical varicocelectomy is regarded as the gold standard due to its superior visualization and lower complication rates. However, precise differentiation between internal and external spermatic vessels during dissection of the spermatic cord remains technically demanding. Intraoperative 20 MHz vascular MicroDoppler ultrasound provides real-time confirmation of arterial flow, improving vessel identification and surgical efficiency.

Methods: This video demonstrates a microsurgical varicocelectomy using intraoperative micro-Doppler guidance. After subinguinal exposure of the spermatic cord, both internal and external spermatic vessels are dissected. The 20 MHz vascular MicroDoppler probe is systematically applied to distinguish arteries from dilated veins. Venous branches are ligated, while arterial branches and lymphatics are preserved under microscopic magnification.

Results: The adjunct use of 20 MHz vascular MicroDoppler allowed rapid and confident identification of multiple arterial branches, significantly increasing the number of arteries preserved compared to standard microsurgery. Moreover, the systematic Doppler-guided assessment reduced intraoperative uncertainty and shortened operative time without compromising safety. The preservation of arterial supply minimizes the risks of testicular atrophy and improves functional outcomes.

Conclusion: 20 MHz vascular MicroDoppler guidance during microsurgical varicocelectomy enhances the precision of spermatic cord dissection. It facilitates differentiation of internal and external spermatic vessels, increases arterial preservation, and decreases operative time. This technique refines the gold standard approach to varicocele repair and should be considered a valuable adjunct in routine practice.