Laparoendoscopic Single-site Surgery with a Single Channel Versus Conventional Laparoscopic Varicocele Ligation: a Prospective Randomized Study

Purpose: The objective of this study was to evaluate the safety and feasibility of single channel laparoscopy in the treatment of patients with varicocele.

Patients And Methods: Ninety patients with clinically palpable varicoceles were randomly assigned to receive laparoendoscopic single-site with a single channel varicocele ligation (LESS[sc]-VL) (n=45) or conventional transperitoneal laparoscopic varicocele ligation (CTL-VL) (n=45). Patient characteristics, perioperative details, total procedural cost, time to return to work, visual analogue scale (VAS) pain score, semen parameters, and cosmetic results were recorded.

Results: There were no differences in operative time (P=0.102), postoperative hospitalization time (P=0.130), total cost (P=0.112), or postoperative complications (P>0.05) between the two groups. Time to return to normal activities was shorter in the LESS(sc)-VL group than that in the CTL-VL group (P=0.018). The mean of all semen parameters were improved statistically 3 months after ligation (P<0.001). The VAS incision pain score was significantly lower 6 and 24 hours after surgery in patients who underwent LESS(sc)-VL(P<0.05). Patients who underwent LESS(sc)-VL had a better cosmetic result, reflected by both the verbal response scale and the numeric scale (P=0.008 and P=0.005, respectively).

Conclusions: LESS(sc)-VL is a safe and effective minimally invasive surgical alternative for varicocelectomy. Compared with CTL-VL, LESS(sc)-VL may decrease postoperative pain and hide the surgical incision better within the umbilicus.