- Preoperative Preparation:
- The patient is evaluated, and anesthesia is administered, typically general or regional anesthesia.
- The patient is placed in a supine position, and the surgical site is prepped and draped to maintain sterility.
- Incision and Exposure:
- A small incision (approximately 2–3 cm) is made in the inguinal or subinguinal region, just above the external inguinal ring.
- The spermatic cord is identified and carefully isolated.
- Use of the Operating Microscope:
- An operating microscope is used to provide magnification (10–25x) for detailed visualization of the small structures within the spermatic cord, including veins, arteries, lymphatics, and the vas deferens.
- Isolation of Structures:
- The spermatic cord is opened to access the veins in the pampiniform plexus.
- Using fine microsurgical instruments, the surgeon identifies and separates the dilated veins from surrounding structures, such as:
- Testicular artery: This must be carefully preserved to maintain blood flow to the testicle.
- Lymphatic vessels: Preserving these prevents postoperative complications like hydrocele (fluid accumulation around the testicle).
- Vas deferens: This is identified and protected to avoid damage to the spermatic duct.
- Ligation of Dilated Veins:
- The dilated veins are carefully ligated and divided using nonabsorbable sutures.
- Typically, multiple veins are ligated to ensure complete elimination of venous reflux.
- Closure:
- Once all appropriate veins have been ligated, the spermatic cord is returned to its normal position.
- The incision is closed in layers using absorbable sutures for the deeper layers and nonabsorbable or skin glue for the skin.
- Postoperative Care:
- The patient is observed for a short time postoperatively and can usually return home the same day.
- Instructions are given regarding wound care, activity restrictions, and pain management.