Microanatomy of the Left and Right Spermatic Cords at Subinguinal Microsurgical Varicocelectomy: Comparative Study of Primary and Redo Repairs

ObjectivesTo examine and compare the left and right spermatic cord arterial and lymphatic anatomy identified at primary and redo microsurgical subinguinal varicocelectomy.MethodsWe reviewed the operative reports of 335 consecutive microsurgical varicocelectomies performed by a single surgeon: 325 primary repairs and 10 reoperations. We recorded number of testicular arteries (internal and external spermatic) and lymphatic channels preserved at subinguinal microsurgical varicocelectomy, and evaluated the relationship between the right and left vascular anatomy at bilateral varicocelectomy.ResultsA total of 235 left-sided and 90 bilateral primary repairs were performed. A mean (± standard deviation) number of 2.4 ± 1.0 arteries and 4.6 ± 1.5 lymphatics were identified during the left-sided repairs. For bilateral repairs, there were 2.4 ± 0.9 arteries and 4.4 ± 1.2 lymphatics on the left and 2.2 ± 0.9 arteries and 4.2 ± 1.3 lymphatics on the right with a significant correlation between the number of right and left internal spermatic arteries (r = 0.42). For the cohort of secondary (redo) varicocelectomies, we identified 2.3 ± 0.6 arteries and 4.8 ± 1.6 lymphatic channels (not significantly different from the primary varicocelectomy cohorts).ConclusionsThe number of arteries and lymphatics preserved at microsurgical varicocelectomy is highly variable, but there is some similarity in the microanatomy of the right and left spermatic cords at the level of the external inguinal ring. The data also suggest that the number of arteries and lymphatic channels identified at a redo varicocelectomy is comparable to that observed during a primary varicocelectomy.