The Research On The Application Of Transumbilical Approach In The Laparoscopic Varicoceletomy

Objective:Study the application and clinical significance of the new transumbilical laproscopic approach through three holes around umbilical ring in High ligation of spermatic vein surgery.Method:We creatively developed the new transumbilical laproscopic approach through three holes around umbilical ring to treat cirsocele subjects in the Minimal Invasive Urology Center of Shandong Province Hospital.we respectively set three 5mm Trocars in the points of 2,6,10 o' clock of the umbilical ring.Of which we placed the sight glass in one of the 5mm Trocar and complete the High ligation of spermatic vein surgery with reservation of the spermatic artery through dual pathways. In our random control study,we collect 156 cirsocele unmarried patients underwent laproscopic High ligation of both sides of spermatic vein from September 2005 to October 2006,which were randomly separated to two groups.81 subjects(Group A)underwent conventional laparoscopic method, while the other 75 subjects underwent transumbilical laproscopic approach through three holes around umbilical ring.All of these subjects were verified as varicole through abdominal ultrasound and physical examination and ruled out the possibility of secondary varicole. Preoperative record included degree of varicole,quality of seminal fluid. And recorded the operation time,blood loss during operation, complication,and hospital day after operation,etc.we conducted follow-up visits in 1 month,3 month,6 month after the operation separately and observe the quality of seminal fluid,operational complication,improvement of symptoms and content level of patients.Results:All the patients of both groups were underwent successful operations with no subject converted to open surgery.The two groups had no significant difference in the quality of seminal fluid,degree of varicole,blood loss during operation,complication,hospital days,etc. there were great difference of the operation time between group A and group B:group A was 22～42min(average 32±4.6min),group B was 35～50min(average 42±5.3min).The content level of group B was distinctly better than group A.There were no recurred subjects through our 1,3,6 month post-operational follow-up visits.And there were no significant difference in the seminal fluid and symptom improvement in these two groups.Conclusion:Transumbilical laproscopic approach through three holes around umbilical ring has the same advantages as the conventional laproscopic high ligation of spermatic vein surgery.The additional advantages of this new approach compared with conventional laparoscopic appendectomy are minimal wounds and scarrings,less postoperative pain and a more rapid return to unrestricted activities.Thus this innovation has magnificent significance especially for unmarried patients and some occupation such as dancer.