Noninsufflative extraperitoneal laparoscopic varicocele ligation.

Currently, most laparoscopic procedures are performed through the intraperitoneal route utilizing standard insufflative technique to create a working space. We report our experience with the new technique of gasless extraperitoneal varicocelectomy performed in eight subfertile men, in which we effectively dissect the retroperitoneum by using a trocar balloon device (peritoneal distention balloon) and maintain the working cavity with a motorized abdominal wall retractor (Laparofan/Laparolift retraction system). In addition to the primary trocar, two valveless secondary trocars are placed, through which either laparoscopic or standard surgical instruments may be used. The spermatic veins are doubly clipped while the artery is preserved in all cases. The mean operative time was 150 +/- 51 min with no intraoperative complications, and all patients were discharged within 24 h. The average days to return to work was 6.5 +/- 3.0 and the average postoperative analgesic requirement (pain pills) was 23.5 +/- 9.9. There were no significant postoperative complications. Exposure and working space provided by the gasless technique are not as satisfactory as the standard insufflative technique, and operative time is far more extensive. To surmount these limitations in gasless laparoscopy, significant developments are required in retraction technology.