Brian P. Jacob, David C. Chen, Bruce Ramshaw, Shirin Towfigh (eds.) - The SAGES Manual of Groin Pain-Springer International Publishing (2016)

26. Chronic Orchialgia: Workup and Management
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oligospermia, and 91 % of the testicular pain patients had a significant
reduction in pain (82 % of these patients had targeted denervation of the
spermatic cord in addition to varicocelectomy). Two recurrences or persistence
of varicocele occurred; one patient developed a small postoperative
hydrocele; two patients had postoperative scrotal hematomas;
and five patients had wound seroma (treated conservatively).
Technique in Detail
A 1–2 cm subinguinal incision is made over the external inguinal
ring. A tongue depressor is placed underneath the cord to keep the cord
elevated. The robot is positioned over the patient. A zero-degree camera
lens is utilized. The Black Diamond microforceps are used in the right
robotic arm, the micro bipolar forceps in the left arm, and the curved
monopolar scissors in the fourth arm. The anterior cremasteric sheath of
the spermatic cord in now incised to separate the cord structures.
The arteries are identified using real-time micro-Doppler (Vascular
Technology Inc, Nashua, NH). All dilated veins are isolated and tied
using 3-0 silk (Fig. 26.8 ) [ 3 ]. Vessels are cut with curved monopolar
scissors. The cord is placed back into through the incision, and the deep
tissue and skin are now closed.
Fig. 26.8. Isolation and ligation of dilated vein (From Brahmbhatt et al. [ 3 ],
with kind permission Springer Science + Business Media).