Varicocelectomy Bilateral Laparoscopic

Varicocelectomy bilateral laparoscopic surgery

A bilateral varicocelectomy is a minimum invasive surgery used in the treatment of varicoceles (enlarged veins in the scrotum) on both sides. The laparoscopic approach takes the surgeon 2-3 small holes on the abdomen to reach and ligate the enlarged veins.

It is usually done in order to enhance:

• Male fertility
• Testicular pain
• Testicular atrophy
• Venous hormonal imbalance associated with varicoceles.

Benefits of Laparoscopic Bilateral Varicocelectomy

• Provides treatment to both sides simultaneously.
• Smaller incisions, less pain
• Quick recovery
• Greater visualisation= less risk of injury to arteries.
• Less frequent occurrence than open surgery.

Bilateral laparoscopic varicocelectomy procedure

Bilateral laparoscopic varicocelectomy is a surgery that is minimally invasive and aims to treat varicoceles on both sides of the scrotum. Using the laparoscopic technique enables concomitant repairs to be made using small abdominal openings, which represent faster healing and a good view of the spermatic vessels.

Step-by-Step Procedure:

Anaesthesia

• General anaesthesia is used in performing the surgery.
• We place the patient in the supine position and prepare and drape the abdomen.

Port Placement

• Incisions of two or three small incisions (5-10 mm) are usually made around the area of the umbilical.
• The main port is passed through which a laparoscope is inserted in order to give a magnified image of inner structures.
• Other ports are aimed at instruments in order to reach both spermatic cords.

Determination of Spermatic Veins

• The inside spermatic vessels of both sides are carefully brought out by the surgeon.
• The veins, artery and lymphatics are clearly seen with the help of the laparoscope.
• The testicular artery is not damaged to keep the blood flowing.

Ligation of Dilated Veins

Isolated and ligated dilated veins causing varicoceles are removed with:

• Titanium clips, or
• Energy-sealing devices
• The artery and lymphatic channels are also handled with care in order to minimize the risk of hydrocele.

Bilateral Repair

• Laparoscopic repair is perfect in bilateral varicoceles because it is repaired on both sides.
• The process guarantees that there is total obstruction of refluxing veins on both sides.

Closure of Incisions

• The instruments are removed after they are ensured to have been cleansed.
• The tiny wounds are sewn with absorbent sutures or skin glue.
• A light dressing is applied.

Duration of Surgery

• Mean operating time: 45 to 90 minutes.
• A little longer with treatment on both sides, although still minimally invasive.

Hospital Stay

• Majority of patients are discharged on the same day or after 24 hours.

Factors Affecting Laparoscopic bilateral varicocelectomy surgery cost India

The following are the main variables that influence the price of bilateral laparoscopic varicocelectomy in India:

Procedure and method of approach

• The equipment and skill needed cause laparoscopic (key-hole) approach to be more expensive than a simple open surgery. 
• Assuming it is not a single side operation, but bilateral (both sides), the cost will be more expensive, as the operative time will be more, and more vessels will have to be ligated. 
• Other technology (advanced laparoscope, energy devices, clips) may increase price.

Type of hospital and locality

• The charges of rooms/OT, surgeon fees, infrastructure cost are high in leading hospitals in big metro cities (Delhi, Mumbai, Bengaluru, Hyderabad). 
• Less premium or smaller city hospital 1 = less expensive.
• Type of room (general ward and deluxe room) and length of stay also become a factor.

Experience and reputation of surgeon

• More seasoned surgeons (in particular, having fertility or microsurgery qualifications) can be more expensive.
• A specialty hospital (urology) will charge more.

Condition / severity / comorbidities of patient

• When the varicocele is large, bilateral or with infertility problems, more complicated surgery might be required- increasing cost. 
• In case the patient has other medical conditions (co-morbidities) that require pre-operative preparation or special anaesthesia, the cost increases.

Pre-examination diagnostics and tests

• Additional charges are ultrasound (scrotal Doppler), semen analysis, blood tests, anaesthesia fitness, etc. 
• Investigations differ depending on hospitals and patients.

Operating theatre time & Anaesthesia time

• Theatre/anaesthesia charges will increase with general anaesthesia and increased time of an operation (due to bilateral).

Inpatient care and aftercare

• Laparoscopic approach can imply the reduction of the stay (day care or 1 day), however, in case of complications or additional stay cost increment.
• The follow-ups, medications, wound care contribute to the total price, as well. 

Problems or secondary surgeries

• In case of additional measures required in the course of surgery, or additional post-operative complications (hydrocele formation, re-surgery), there is an increase in costs.
• Special implants can also be used or better equipment and this can increase the cost.

Best hospital for bilateral laparoscopic varicocelectomy India

• Artemis Hospital, Gurgaon
• Medanta-The Medicity, Gurgaon
• Fortis Memorial Research Institute, Gurgaon
• Max Hospital, Saket

Bilateral laparoscopic varicocelectomy recovery time

The process of recovery following bilateral laparoscopic varicocelectomy is usually faster than that of open surgery since the operation utilizes small keyhole incisions and the procedure provides a faster mobilization. Yet, because of both sides being repaired, there is the possibility of mild pain that can drag a little longer as compared to unilateral cases.

Immediate Recovery (First 24 Hours)

• The majority of the patients are discharged within the same day or within the 24 hours.
• The mild abdominal or groin discomfort is usual.
• The patient should be encouraged to walk a couple of hours following surgery.
• Contemporary swelling or bruising can be noticed in the area of the scrotum or incisions.

Recovery Timeline:

First 3–5 Days

• On either side, mild pain or soreness should be expected.
• Within 3-5 days, patients are allowed to resume their normal lives of going to the office or performing every day duties.
• Weight lifting should be avoided at a weight exceeding 5 kg.

1–2 Weeks

• The level of discomfort decreases greatly.
• Incisions are usually healed in 7-10 days.

Patients can resume:

• Light exercise
• Short walks
• Does not cycle, run, do gym exercises, or do strenuous exercises.

3–4 Weeks

• Majority of patients are able to resume normal activity slowly through exercise, running, and gym.
• The heavy weightlifting must not be undertaken until the surgeon permits.

Sexual Activity

• Can restart after 23 weeks, when pain and swelling have decreased.

Fertility Improvements

• Within 2-3 months, sperm parameters begin to improve.
• Optimal is 3-6 months after surgery.
• After 3 months, semen analysis is normally recommended to be repeated among couples with intention to have a baby.

Laparoscopic varicocelectomy bilateral success rate

A bilateral laparoscopic varicocelectomy is mainly successful because laparoscopic technique gives a great view of both spermatic cords and the procedure could be done through small incisions.

Overall Success Rate

• Success rate of 85-95, in full blockage of veins of refluxing and removal of varicocele.
• Northern recurrence: 1-5% of the cases with respect to surgeon skill and vein structure.

Pain Relief Success Rate

• After the surgery, chronic scrotal pain is relieved significantly or completely in 80-90% of the patients.
• Bilateral cases can cause a little longer period of soreness in the beginning and the long term outcomes are outstanding.

Success rate of fertility Improvement

• 60-80% is improved in semen parameters (count, motility, morphology).
• Improvement in the natural conception rates 40-70%: in younger patients or when the causes of infertility are not present at all.

Conclusion

Laparoscopic varicocelectomy is a very viable and least invasive surgery that can be effectively done to patients who have varicoceles on both sides of the scrotum. Laparoscopic technique has better visualization, less pain during post-surgery and faster healing than traditional open techniques. It also has high success rates in pain relief, semen improvement, as well as in the reduction of recurrence, hence making it one of the most preferred methods of bilateral varicocele repair. When done by a qualified urologist, the operation has long term advantages particularly in men who want to have an increased likelihood of procreation or reduced chronic scrotal pain. In general, bilateral laparoscopic varicocelectomy is a safe, dependable, and result-based procedure that can be used to treat varicoceles.

Varicocelectomy Bilateral Laparoscopic surgery in India with GetWellGo

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FAQ

How soon can I go back to work or normal life?

• Within 3-5 days most people are able to resume work in the office or other less heavy tasks.

Can I resume sex after childbirth?

• After 2-3 weeks (when the pain and the swelling are minimized) it is possible to resume sexual activity.

Would I require a postoperative follow-up?

• Yes. Wound inspections, scrotal and semen inspection after 3 months, are generally included in follow-up to determine whether or not fertility has been improved.

Is the procedure painful?

• The pain is usually mild to moderate and can be handled using painkillers that are administered orally. The level of discomfort reduces considerably in a couple of days.