How I Do It: Vitom 3D in Microsurgical Varicocele Repair

Kusuma Duarsa. G W

A 31-year-old male patient with bilateral grade 3 varicocele and primary male infertility underwent microsurgical varicocelectomy utilizing the Marmar and Goldstein procedure. This technique, recognized as the gold standard for varicocele repair, was performed with the assistance of the Vitom 3D system, which provided 10–12x magnification to enhance visualization, precision, and surgical accuracy. The microsurgical approach is designed to selectively ligate dilated veins while preserving the arterial and lymphatic structures, thereby reducing the risk of complications such as hydrocele formation and testicular atrophy. 

This video presents a step-by-step demonstration of the surgical procedure, highlighting critical intraoperative maneuvers, including meticulous soft tissue dissection, identification and preservation of the testicular artery and lymphatics, and targeted ligation of dilated veins under high-magnification visualization. The use of the Vitom 3D system enhances depth perception and ergonomic comfort, facilitating precise manipulation of microsurgical instruments. Compared to conventional techniques, this approach minimizes iatrogenic injury and optimizes postoperative outcomes, with benefits such as reduced recurrence rates and improved sperm parameters. 

Microsurgical varicocelectomy is a well-established intervention for male infertility associated with varicocele, with multiple studies supporting its efficacy in enhancing spermatogenesis and fertility potential. The integration of advanced visualization technologies, such as the Vitom 3D system, further refines the procedure, providing superior operative control and reducing surgeon fatigue. This video serves as an educational resource for urologists and reproductive surgeons, demonstrating best practices in modern microsurgical varicocelectomy.

This procedure was conducted at Surya Husada Denpasar Hospital and presented at MCUE 13.

The authors declare that the seminal vesiculoscopy equipment and consumables used in this case report were routinely purchased by the hospital, and the authors have no direct interests with the relevant manufacturers. No commercial organization or individual sponsored or intervened in this study. The content of this article is based on real clinical practice and there is no conflict of interest.

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