Marte Antonio, Sabatino Maria Domenica, Borrelli Micaela, Cautiero Pasquale, Romano Mercedes, Vessella Antonio, Parmeggiani Pio
Pediatric Surgery, Second University of Naples, Naples, Italy.
J Laparoendosc Adv Surg Tech A. 2007 Apr;17(2):272-5. doi: 10.1089/lap.2006.0046.
We review our experience with laparoscopic Palomo varicocele ligation using the LigaSure device in children and adolescents.
Between June 2003 and December 2004, 25 varicoceles were treated by laparoscopic Palomo varicocele ligation using LigaSure vascular sealing. Patient ages ranged from 10 to 19 years (mean, 14.5 years). Indications for surgery included grade II-III varicocele or ipsilateral testicular hypotrophy. One patient was affected by recurrent contralateral inguinal hernia and 2 presented with an ipsilateral patent processus vaginalis. We placed a 5-mm umbilical port for access, and kept pneumoperitoneum below 15 mm Hg. Under laparoscopic guidance, two additional ports of 3 and 5 mm were inserted in the lower right and left quadrants, respectively. Once the vessels were isolated, the vascular sealant was applied 3-4 times to ensure coagulation of the spermatic vessels; the vessels were then divided with laparoscopic 5-mm scissors. Inguinal hernia and patent processus vaginalis were treated according to Schier's technique. All procedures were performed in our day surgery facility.
Mean operative time was 18 minutes, which is significantly less than the time required in a similar group of 12 patients who underwent laparoscopic clip ligation. There were no perioperative complications. Eleven of 16 patients recovered testicular size. Two patients had postoperative hydrocele: the first was treated successfully with scrotal aspiration, while the other patient required scrotal hydrocelectomy.
Laparoscopic Palomo varicocele sealing can be performed safely and rapidly and is highly successful in correcting varicoceles in young males. We also found it to be the ideal technique to correct the associated inguinal hernia or patent processus vaginalis.
我们回顾了在儿童和青少年中使用LigaSure设备进行腹腔镜Palomo精索静脉曲张结扎术的经验。
2003年6月至2004年12月期间，25例精索静脉曲张患者接受了使用LigaSure血管闭合技术的腹腔镜Palomo精索静脉曲张结扎术。患者年龄在10至19岁之间（平均14.5岁）。手术指征包括II-III级精索静脉曲张或同侧睾丸萎缩。1例患者患有复发性对侧腹股沟疝，2例患者存在同侧鞘状突未闭。我们置入一个5毫米的脐部端口用于进入，并将气腹压力保持在15毫米汞柱以下。在腹腔镜引导下，分别在右下象限和左下象限插入另外两个3毫米和5毫米的端口。一旦血管分离，应用血管密封剂3-4次以确保精索血管凝固；然后用腹腔镜5毫米剪刀切断血管。腹股沟疝和鞘状突未闭根据Schier技术进行处理。所有手术均在我们的日间手术设施中进行。
平均手术时间为18分钟，明显少于一组12例接受腹腔镜夹子结扎术的类似患者所需的时间。无围手术期并发症。16例患者中有11例睾丸大小恢复。2例患者术后出现鞘膜积液：第一例通过阴囊穿刺抽吸成功治疗，而另一例患者需要进行阴囊鞘膜积液切除术。
腹腔镜Palomo精索静脉曲张闭合术可以安全、快速地进行，并且在纠正年轻男性的精索静脉曲张方面非常成功。我们还发现它是纠正相关腹股沟疝或鞘状突未闭的理想技术。
