GASLESS LAPAROSCOPIC VARICOCELE LIGATION - EXPERIENCE WITH NEW INSTRUMENTATION AND TECHNIQUE FOR RETROPERITONEAL AND INTRAPERITONEAL APPROACHES

Laparoscopic access to the retroperitoneum without abdominal insufflat ion has recently been made possible by devices designed to create a di lated laparoscopic cavity maintained by a fixed retraction system, Thi s technique was applied in 10 patients undergoing laparoscopic ligatio n of the internal spermatic vein via extraperitoneal and intraperitone al approaches, Gasless laparoscopic varicocelectomy was completed in 7 of 8 men by the extraperitoneal route and in neither of the 2 men app roached intraperitoneally. The mean operative time was 170 +/- 55 min and postoperative pain exceeded the norm for standard insufflative lap aroscopic varicocelectomy, Whereas certain theoretical advantages are offered by the gasless extraperitoneal approach to varicocele ligation , exposure through the gasless technique is currently suboptimal, Furt her development of ''retraction'' technology is required, prior to its routine application for varicocele ligation.